Which physical finding is associated with pernicious anemia?

• A. Splenomegaly and hepatomegaly.
• B. Petechiae and ecchymosis.
• C. Loss of position and vibratory sensation.
• D. Cheilosis and koilonychia.

Answer: (C)

Pernicious anemia causes vitamin B12 deficiency, which can lead to subacute combined degeneration of the spinal cord. This specifically damages the dorsal columns that carry proprioception and vibration information. When these pathways are impaired, the person loses accurate sense of where their limbs are (loss of position) and their ability to feel vibration, producing diminished proprioception and vibratory sensation. This neurologic involvement is a hallmark of B12 deficiency from pernicious anemia, distinguishing it from findings seen in iron deficiency (such as koilonychia and cheilosis) or in conditions that cause splenomegaly, hepatomegaly, or bleeding (petechiae/ecchymosis).