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Behavioural changes, such as sudden mood swings and trouble sleeping Becoming extremely fatigued despite getting enough sleep Problems with balance, experiencing clumsiness and vertigo Cold and tingly or burning sensations in your extremitiesWeak nails, a pale or yellow-ish complexion and dry skin Trouble focusing or concentrating on tasks Loss of appetite and resulting weight lossShortness of breath and rapid breathing Mouth ulcers or a cracked tongue Image of Gastric Cancer and Pernicious Anemia How to diagnose pernicious anemia Pernicious anemia can only be diagnosed by a medical professional