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[20] Pernicious anemia may be present without a person experiencing symptoms at first, over time, feeling tired and weak, lightheadedness, dizziness, headaches, rapid or irregular heartbeat, breathlessness, glossitis (a sore red tongue), poor ability to exercise, low blood pressure, cold hands and feet, pale or yellow skin, easy bruising and bleeding, low-grade fevers, tremor, cold sensitivity, chest pain, upset stomach, nausea, loss of appetite, heartburn, weight loss, diarrhea, constipation, severe joint pain, feeling abnormal sensations including tingling or numbness to the fingers and toes ( pins and needles ), and tinnitus, may occur

Turning or extending the neck can worsen symptoms

A few require genetic testing to confirm hereditary intrinsic factor deficiency before approving injectable therapy, despite pernicious anemia predominantly being an acquired autoimmune condition

For concentration-sensitive assays, researchers should use documented peptide content when available rather than assuming that gross vial mass equals net active peptide mass