Treatment of severe pernicious anemia: no association with sudden death.

An increased risk of early, sudden death after treatment of megaloblastic anemia has been reported. This was particularly true for severe anemia, with a mortality rate of 14%. Because no other investigations of this phenomenon have been done since these alarming findings, the experience at our medical center was reviewed. Of 219 patients with pernicious anemia, 101 had severe anemia (hemoglobin less than or equal to 80 g/L). None of the severely anemic patients died during hospitalization. Only one death occurred among all 219 patients and this death was not unexpected but attributable to coexisting diseases. Pernicious anemia, even when severe, is not associated with increased mortality after therapy.