Pernicious (B12 deficiency) anemia What we need to know

26.02.2024

Table of Contents

Same as: Biermer's Disease

Pernicious anemia B12 vitamin deficiency As a result, the situation is developed. It is often based on an autoimmune process, during which autoantibodies develop against the mucosa and nerve cells of the gastrointestinal tract. Due to the developed immune inflammation, the absorption of vitamin B12 from the small intestine is inhibited, which ultimately causes the development of anemia.

In the case of vitamin B12 deficiency, the process of normal erythrocyte synthesis is disturbed, which affects the oxygen supply of tissues.

Vitamin B12 deficiency is often associated with folate deficiency, which leads to the development of megaloblastic anemia.

Without treatment, pernicious anemia has a serious impact on:

on the digestive system, causes bloating, nausea, weight loss
on the nervous system, (muscle weakness, numbness or sensitivity disorders in the limbs, dementia)
on the cardiovascular system (heart palpitations, arrhythmia)
on general condition (general weakness and fatigue)

Mechanism of disease

Vitamin B12 deficiency may develop in conditions of intrinsic absorption factor deficiency. Intrinsic factor is a glycoprotein, which is located in the small intestine mucosa, binds to cobalamin (vitamin B12) received with food and promotes its absorption in the intestinal wall. Autoantibodies developed against intrinsic factor or gastric parietal cells are often associated with other autoimmune processes (eg Hashimoto's thyroiditis, Addison's disease, ulcerative colitis, type I diabetes mellitus. Also gastritis of any origin, excessive alcohol consumption, proton pump inhibitors, bariatric surgery, etc.) and disrupts absorption processes.

The frequency of pernicious anemia is 0.1% of the general population, and it reaches 60% in patients over 1.9 years of age.

The term "pernicious" (dangerous, destructive) originates from the past, when anemia was considered a fatal disease, and without treatment such patients died.

Today, there are many diagnostic and treatment options, which provide the opportunity to recognize this or that form of anemia in time and start treatment.

Symptoms

Vitamin B12 deficiency progresses slowly in the body, therefore the symptoms of pernicious (or any) anemia develop gradually:

Diarrhea or constipation
Feeling dizzy
Loss of appetite
Pale skin
Shortness of breath even with slight physical exertion
Heart palpitations
Oral mucosa and tongue damage - stomatitis, glossitis.

Long-term B12 or folic acid deficiency can cause neurological disorders, infertility, heart disease, pregnancy complications, and even birth defects.

Diagnosis

Pernicious anemia can be suspected based on the anamnesis and objective examination data of a person. The diagnostics is confirmed by the results of laboratory studies:

B12 Vitamin Determination - a low level of the vitamin confirms the diagnostics of pernicious anemia.
Folat - Vitamin B12 deficiency is often associated with folate deficiency. To differentiate from megaloblastic anemia, it is necessary to control both indicators at the same time.
General blood test (The presence of anemia is determined by the amount of blood-shaped elements - erythrocytes, platelets and leukocytes).
reticulocytes Quantification (reflects the ability of the bone marrow to produce erythrocyte progenitor cells)
Lactate dehydrogenase Determination of LDH (an increase in its value is characteristic of pernicious anemia)
of serum bilirubin Definition
of methylmalone Determination of acid (an increase in its concentration confirms B12 deficiency anemia)
of homocysteine Determination (its increased rate is characteristic of B12 deficiency
Parietal cells of the stomach Determination of antibodies (for identification of autoimmune process) - in 90% of cases of pernicious anemia, the titer of autoantibodies of parietal cells is increased.
Intrinsic factor antibodies (Megaloblastic anemia, along with low serum vitamin B12 and intrinsic factor autoantibodies confirm the diagnostics of pernicious anemia). However, the absence of intrinsic factor antibodies does not rule out the diagnostics, because in 50% of cases they are not detected at all.

Also, if necessary, an endoscopic examination of the stomach and duodenum is performed - to detect degenerative-atrophic processes of the mucous membrane.

Disease treatment and management

Since the disease is related to vitamin B12 absorption disorders, its treatment consists of providing the vitamin in oral (tablet) or parenteral (injection) form. The duration of treatment and dosage is determined by the attending physician based on clinical and laboratory data.

Regular laboratory monitoring is important to assess the effectiveness of treatment.

forecast

Depending on the cause of vitamin B12 deficiency, it may not be possible to cure it (eg, autoimmune diseases), however, supplementing vitamin B12 deficiency in most cases significantly improves the patient's well-being and reduces symptoms.

In addition to taking medicine, it is important to enrich the diet with natural products containing vitamin B12, such as: meat and fish products, milk, eggs, legumes, cereals and others.