pernicious anemia

[dkelly]

What is pernicious anemia?  Symptoms?  Possible causes?
Are people with this subject to liver disorders?  Is this something criticl or could it become?

[virgo57]

This is a cut and paste..hope it helps :)

  

    
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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. The bone marrow sample is examined in the laboratory to help rule out other causes of anemia and red cell abnormalities.
Expected Duration

With proper treatment, symptoms of vitamin B12 deficiency begin to improve within a few days. In vegans and other patients whose B12 deficiency is diet-related, symptoms will not return if these patients take oral B12 supplements or change to a B12-rich diet. In patients whose vitamin B12 deficiency is not related to diet, the condition is a lifelong disorder that may cause irreversible nerve damage if the patient does not receive lifelong treatment.

Prevention

To prevent vitamin B12 deficiency, vegans should take adequate amounts of vitamin B12 supplements to make up for their dietary shortage.

In many patients, vitamin B12 deficiency is not preventable. However, once it is diagnosed, long-term treatments to raise B12 levels will prevent symptoms from recurring.

Treatment

Vitamin B12 injections are the definitive treatment for this disorder. When injections first are administered, a patient with severe symptoms may receive five to seven during the first week to restore the body's reserves of this nutrient. A favorable response usually is seen within 48 to 72 hours. Once B12 reserves normalize, lifelong therapy (with vitamin B12 injections every month or two) is needed to prevent symptoms from recurring in patients whose vitamin B12 deficiency is not diet-related. For these patients, neither oral supplements nor dietary changes are useful ways to raise B12 levels. However, these patients should continue to eat a well-balanced diet that provides other nutrients (folic acid, iron and vitamin C) necessary for healthy blood cell production. Sometimes patients can take high doses of oral B12 to provide replacement instead of undergoing injections, but a physician should closely supervise this. A new product developed to avoid the need of injections is an intranasal B12 spray that is used weekly.

In patients whose vitamin B12 deficiency is related to overgrowth of intestinal bacteria, treatment with oral antibiotics, such as tetracycline (several brand names) or ampicillin (Omnipen, Polycillin) may stop bacterial overgrowth and allow vitamin B12 absorption to normalize. In patients whose vitamin B12 deficiency is related to immune disorders, treatment with glucocorticoid medications may be helpful.

In severe cases of pernicious anemia, particularly among the elderly, transfusions of packed red blood cells may be necessary. Because elderly patients with vitamin B12 deficiency are at increased risk for stomach cancers, these patients should be monitored closely with periodic doctor's visits.

When To Call A Professional

Contact your doctor for a physical exam if you experience unexplained fatigue, palpitations, shortness of breath, sore tongue or any other symptoms of vitamin B12 deficiency. This is especially true if you are a vegan, a person older than age 50 and of African-American or Northern-European descent, a diabetic, a patient with an autoimmune disorder or a patient who has undergone total or partial gastrectomy.

Prognosis

Prognosis is excellent because this form of anemia responds well to treatment. However, since any existing nerve cell damage cannot be reversed, some residual damage to the nervous system may remain in patients who have sought treatment late in their illness.

Additional Info

National Heart, Lung and Blood Institute (NHLBI)
6701 Rockledge Dr.
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: [phone]
E-Mail: ***@****
http://www.nhlbi.nih.gov/

Last updated March 02, 2001

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