What is pernicious anemia ?
Pernicious anemia, caused by a vitamin B12 uptake problem. Earlier this disease was fatal. Treatment for this is possible by means of the regular administration of vitamin B12, per injection or orally.
Because this condition through improved nutrition nowadays usually no anemia is present (or at a later stage), nowadays speaks also of Addison's disease-Biermer. Addison and Biermer are two researchers who have made important contributions to the knowledge about this disease.
Pernicious anemia can see a macrocytic anemia in the blood reflect. That is to say that the red blood cells are increased. There lacks a building block for hemoglobin, namely vitamin B12. The uptake of vitamin B12 takes place in the last part of the small intestine. To do this, it must first be linked to intrinsic factor that is produced by the stomach wall. Because of an autoimmune response against the parietal cells of the stomach is the production of intrinsic factor disrupted and vitamin B12 can be sufficiently absorbed into the body.
Pernicious anemia symptoms
The symptoms are related to the direct result of the disease, namely a reduced ability of blood to carry oxygen to areas that need it. There is a gradual deterioration of the nervous system.
The symptoms begin vague, diverse and variable so the possibility exists for the failure to recognize the disorder. Very gradually increases the severity of symptoms and discomfort. In disorders or diseases associated with great fatigue, exhaustion, depression, memory problems, muscle, joint and nerve problems and psych (IatR) ical symptoms, it is advisable to check their B12 levels. A B12 deficiency can exist without the existence of anemia.
The following symptoms may be present. The symptoms need not be all available, and also not simultaneously. After exercise, the symptoms may worsen.
- Sore tongue
- Decreased position sense
- Neurological problems (nerve problems)
- Psychological / psychiatric complaints
- Lack of concentration, derealisation
- Aphasia
- Tingling, pricking, numbness
- Dizziness
- Fatigue, exhaustion, somnolence
- Chest tightness, shortness of breath, palpitations, increased heart rate
- Heavy or stiff joints feeling
- Hyperesthesia
- Muscular weakness, cramps, shaking, pains, weakness
- Nausea
- Diarrhea
- Weight loss
- Feeling cold
- Eye problems
- Menstruation problems
- Dental and gum problems
What causes pernicious anemia ?
A typical cause of a disorder in the recording can be found in Crohn's disease, wherein the inflamed large intestine, and is often also the last part of the small intestine, the ileum, where the vitamin B12 (cobalamin), is recorded.
Another cause is a chronic gastritis which there is no intrinsic factor is made. It can also be created by an autoimmune reaction are disrupted the production of parietal cells causing no intrinsic factor. This latter condition will be pernicious anemia.
If there is already an auto-immune disease, there is an increased risk of other (autoimmune) disorders, such as, for example, thyroid problems, vitiligo (pigment disorder) and / or Addison's disease (primary adrenal insufficiency).
In some cases, genetic predisposition plays (e.g. for auto-immune diseases), a role, and pernicious anemia occurs sooner or later on when several members of a family.
Chronic use of (metformin) or an antacid can result in vitamin B12 deficiency due to reduced uptake. In the elderly a reduced effect of the intestine may be a cause.
In people with a vegetarian or vegan diet may be a vitamin B12 deficiency can occur because B12 is only found in food of animal origin.
In people who have undergone gastric bypass (stomach tube ', gastric bypass) can reduce the absorption of B12. The stomach is thus reduced so that also the surface of the stomach wall that B12 can absorb is reduced.
Pernicious anemia treatment
The treatment often consists of the supplementation of vitamin B12 with intramuscular injections.
The frequency of injections can vary from twice per week (long-term, this is the initial dosage in addition to the resulting shortage until the symptoms decline appreciably), gradually decreasing to a once every two months maintenance dose to maintain the B12 levels. Many patients can end up with a frequency of one injection per month intervals. The frequency of injections, however, must always be determined based upon the complaints.
Research has shown that by providing tablets with a high dose of vitamin B12 be achieved in tablet form, equally good results, even when the vitamin B 12 is absorbed by the body. When the body no longer absorbs vitamin B12, there must never be started with tablets, but should be started immediately with IM (inter-muscular) injection.
The B12 deficiency should be replenished throughout life. The liver is in a healthy person an amount of vitamin B12 stored for 3 years. A shortage addressed by a recording problem is this reserve, in most cases already (largely).
Pregnancy and lactation
When a woman is pregnant or breastfeeding, it is important that it is adequately treated with injections. A deficiency of cobalamin inhibits the development of the child with the risk of permanent underdevelopment.
Signaling
Pernicious anemia is more common as people grow older. 65 shows a statistically borderline age. In the elderly bowel function decreases. Came to them more diabetes mellitus. The concomitant medication (eg. Metformin) can disrupt the absorption of vitamin B12.
Even when children can prevent a B12 deficiency, especially when there is a hereditary (autoimmune) component. For children are higher reference values.
Blood tests
The following blood tests may be discussed at a possible cobalamin absorption disorder:
- Cobalamin (B12) = detection of deficiency of cobalamin in the blood
- Methylmalonic acid (MMA) = detection of deficiency of cobalamin in the tissues
- Homocysteine
- If antibodies demonstrate = (any) antibodies against intrinsic factor
- Folic acid (B11) = a deficiency of cobalamin may be associated with a deficiency of folate folate since it is important for the recording operation of B12
- B6 = B11 as important for the absorption effect of B12
- Hemoglobin
- Ferritin
- MCV