Which finding indicates successful treatment of pernicious anemia?

Which finding indicates successful treatment of pernicious anemia?

• A. Decreased folic acid level and increased enlarged red blood cells
• B. Decrease intrinsic factor and increased vitamin B12 excreted in urine
• C. Increased vitamin B12 levels and decreased number of enlarged red blood cells
• D. Decrease in hydrochloric acid levels in gastric secretion

Answer: (C)

When pernicious anemia is successfully treated, you expect the patient to have rising levels of vitamin B12 in the blood and a normalization of red blood cell size. Replacing B12 corrects the underlying deficiency, allowing DNA synthesis in developing erythrocytes to proceed properly, which reduces the megaloblastic (abnormally large) cells the condition causes. So seeing increased vitamin B12 levels along with a decrease in enlarged red blood cells reflects that the body is now replete with B12 and the bone marrow is producing normal-sized, healthy red cells. The other findings point to ongoing deficiency or unrelated gastric changes rather than a response to therapy—for example, continued low intrinsic factor with ongoing B12 loss wouldn’t indicate improvement, and changes in gastric acid or folate status don’t directly demonstrate reversal of the B12 deficiency and its hematologic effects.

When pernicious anemia is successfully treated, you expect the patient to have rising levels of vitamin B12 in the blood and a normalization of red blood cell size. Replacing B12 corrects the underlying deficiency, allowing DNA synthesis in developing erythrocytes to proceed properly, which reduces the megaloblastic (abnormally large) cells the condition causes. So seeing increased vitamin B12 levels along with a decrease in enlarged red blood cells reflects that the body is now replete with B12 and the bone marrow is producing normal-sized, healthy red cells. The other findings point to ongoing deficiency or unrelated gastric changes rather than a response to therapy—for example, continued low intrinsic factor with ongoing B12 loss wouldn’t indicate improvement, and changes in gastric acid or folate status don’t directly demonstrate reversal of the B12 deficiency and its hematologic effects.