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Rare Disease Education: Pernicious Anemia Editor: Kelsey LaFayette, DNP, RN, FNP-C "When you hear hoofbeats, think of horses, not zebras, is a common saying in medical education that means you should think of common conditions first, instead of rare ones, in making a diagnosis

While PEM can be triggered by muscular exercise, it can, in the same patient, also be triggered by other stressors, including cognitive exercise, mental or emotional strain, orthostatic stress or sensory overload

Nuclear GAPDH also enhances the activity of the APEX1 (apurinic/apyrimidinic endodeoxyribonuclease 1) encoded enzyme (also referred to as AP site endonuclease 1, APE1) to promote the repair of damaged DNA