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Gastroenterology (Expert Forum)
pernicious anemia
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pernicious anemia
by dkelly, Jun 21, 2002 12:00AM
What is pernicious anemia? Symptoms? Possible causes?
Are people with this subject to liver disorders? Is this something criticl or could it become?
Are people with this subject to liver disorders? Is this something criticl or could it become?
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Vitamin B12 DeficiencyWhat Is It?
Symptoms
Diagnosis
Expected Duration
Prevention
Treatment
When To Call A Professional
Prognosis
Additional Info
What Is It?
Vitamin B12 deficiency is defined by low levels of stored B12 in the body that can result in anemia (reduced red blood cell count). Vitamin B12, available only in animal foods (meat and dairy products) or yeast extracts (such as brewer's yeast), is needed to produce an adequate amount of healthy red blood cells in the bone marrow.
Vitamin B12 deficiency can develop for the following reasons:
Absence of intrinsic factor (IF)(also called pernicious anemia) — IF is a protein that is secreted by cells of the stomach lining. IF attaches to vitamin B12 and takes it to the intestines to be absorbed. Absence of IF is the most common cause of pernicious anemia, and it is typically the result of an immune-related atrophy (shrinkage) of the stomach lining. This condition often is seen in elderly people of African-American or Northern-European descent. In these patients, pernicious anemia develops at about age 60, and both sexes are affected equally. In children, decreased levels of IF can be an inherited condition related to genetic factors. In this case, low levels of IF produce symptoms of juvenile pernicious anemia in patients younger than age 10.
Pernicious anemia occurs more commonly in patients who already suffer from diseases that are linked to immune system abnormalities, such as Graves' disease, myxedema, thyroiditis, and idiopathic adrenocortical insufficiency.
Removal or destruction of the stomach — Vitamin B12 deficiency can develop in patients who have undergone surgery to remove part or all of the stomach (total or partial gastrectomy), and in patients whose stomach lining was destroyed because of swallowing corrosive chemicals in attempted suicide.
Overgrowth of bacteria — Some patients develop vitamin B12 deficiency as a result of conditions that slow the movement of food through the intestines ( diabetes, scleroderma, strictures, diverticula ), allowing intestinal bacteria to multiply and overgrow. Overgrowing bacteria steal B12 for their own use, rather than allowing it to be absorbed by the body.
Dietary deficiency — Vegans (strict vegetarians who do not eat any meat, fish, egg or dairy products) can develop vitamin B12 deficiency because they lack vitamin B12 in their diets. In patients with bulimia or anorexia nervosa, vitamin B12 deficiency also can be related to dietary factors. However, your liver can store vitamin B12 for up to five years, so dietary causes of this anemia are rare.
Symptoms
Symptoms tend to develop slowly and gradually and may not be immediately recognized. As the condition worsens, common symptoms can include:
Weakness and fatigue
Lightheadedness and dizziness
Palpitations and rapid heartbeat
Shortness of breath
Bleeding gums and mouth sores
A sore tongue that has a red, beefy appearance
Nausea or poor appetite
Weight loss
Diarrhea
Yellowish tinge to the skin and eyes
In the long term, low levels of B12 also can lead to irreversible nerve-cell damage, producing the following symptoms: numbness and tingling in the hands and feet, difficulty walking, muscle weakness, irritability, memory loss, dementia, depression and psychosis.
Diagnosis
Your doctor will ask you about your diet and about any family history of anemia. Your doctor also will review your medical history for medical illnesses (diabetes, immune disorders) or surgeries (total or partial gastrectomy) that can lead to B12 deficiency.
Your doctor may suspect that you have vitamin B12 deficiency based on your medical history and symptoms. To confirm the diagnosis, he or she will perform a physical examination and order laboratory tests to be done. During the physical examination, your doctor will look for a red, beefy tongue, pale or yellowish skin, a rapid pulse, and heart murmurs (resulting from an anemia-related increase in blood flow demands on the heart). Laboratory tests will include:
Standard blood tests to measure the level of red blood cells and check their appearance — In vitamin B12 deficiency, red blood cells are unusually large and have an abnormal appearance.
Blood tests to measure B12 levels — Levels of iron and folate also may be measured to check for co-existing deficiencies in these nutrients.
Blood test and 24-hour urine test to measure excretion of methylmalonic acid — Blood and urine levels of methylmalonic acid are increased in people with B-12 deficiency.
Bone marrow biopsy — Occasionally, a bone marrow biopsy is performed to help confirm the diagnosis. In this procedure, a small sample of bone marrow is taken by inserting a needle into the pelvic bone just below the waist on either side of the spine