Long-term management of pernicious anemia includes?

• A. Lifelong oral iron therapy
• B. Lifelong IM B12 injections
• C. Periodic IV fluids
• D. Splenectomy

Answer: (B)

Pernicious anemia is caused by autoimmune loss of intrinsic factor, so vitamin B12 cannot be reliably absorbed from the gut. The essential, ongoing treatment is replacing vitamin B12 for life to restore stores and prevent relapse or neurological complications. The most dependable method is lifelong intramuscular injections of vitamin B12, which bypasses the need for intrinsic factor and maintains normal B12 levels. Other options like periodic IV fluids or splenectomy do not address the underlying deficiency, and iron therapy would not correct a B12 deficiency. While some patients can absorb large oral doses, the standard, most reliable long-term approach for pernicious anemia is lifelong IM B12 injections.