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Pernicious Anemia (Vitamin B-12 Deficiency) (cont.)

Exams and Tests

As with any medical problem, the first step in the evaluation is a thorough history and physical examination. Other diagnostic tests that can help establish the diagnosis of pernicious anemia or rule out other causes of the symptoms include:

  • a complete blood cell count (CBC) to establish whether anemia is present and to further characterize the type of anemia;

  • examination of a blood smear (peripheral smear) under a microscope, often performed in association with a CBC;

  • other blood tests, for example tests to measure vitamin B-12 levels, auto-antibodies to IF or to stomach lining cells, blood iron and iron-binding capacity levels, folate levels (which can also be low when vitamin B-12 levels are low);

  • tests to measure blood levels of methylmalonic acid or homocysteine, both of which may be sensitive indicators of vitamin B-12 deficiency;

  • bone marrow aspiration or bone marrow biopsy may be recommended in some cases to examine for the presence of bone marrow disorders; and

  • the Schilling test, a measure of how well the body can absorb vitamin B-12, is less commonly used today than in the past.

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