Patients may have extensive symmetrical pigmentation, especially in curved parts of the body, palms, soles, nails and oral cavity. The hair becomes gray and the nails may be pigmented. Vitamin B12 deficiency caused by pernicious anemia can cause leukoplakia and alopecia areata.
Patients may have anemia in the blood system, such as anemic face, fatigue, hepatosplenomegaly, and severely ill patients may have skin petechiae and ecchymosis.
Symptoms appear late, with or without anemia, neurological disorders, spinal cord degeneration, demyelination and severe neurological symptoms, and even dementia, coma and death; children with vitamin B12 deficiency can cause peripheral nerve degeneration , spinal cord subacute combined degeneration is a typical neuropathy. It may also have atypical neurological manifestations such as sluggish expression, mental retardation, decreased sensitivity to the environment, hypotonia, and paralysis.
Digestive symptoms include vomiting and diarrhea. Severe patients may have fever, mild yellow staining of the sclera, and hepatosplenomegaly.
Anemic heart disease and heart failure occur.
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