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Castle noted: (1) gastric achlorhydria precedes the other clinical manifestations of pernicious anemia, and (2) even when the blood of a patient with pernicious anemia is returned to normal with liver feeding, gastric achlorhydria persisted (139)
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Supplies Important notes Always use sterile, new U-100 insulin syringes (29-31 gauge) and dispose of them in a sharps container
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It typically presents as macrocytic megaloblastic anemia and neurological impairments, including sensory and motor disfunctions, predominantly in the lower extremities, ataxia, and in more advanced stages cognitive decline progressing to dementia, as well as psychiatric disturbances ( Subclinical B12 deficiency, however, is far more prevalent, affecting up to 26% of the general population
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