(Vitamin B-12 Deficiency)
Pernicious anemia results from the failure of the digestive tract to absorb vitamin B-12. Vitamin B-12 (also called cobalamin) is needed for making red blood cells and keeping the nervous system functioning. This type of anemia usually affects adults of both sexes, between ages 40 and 70.
• Symptoms develop slowly. It may take time to notice. • Weakness, especially in the arms and legs. • Bright red, smooth, burning, or sore tongue. • Numbness or tingling in the hands and feet. • Difficulty maintaining proper balance and walking. • Loss of sense of position, especially in a dark room. • Nausea, appetite loss, and weight loss. • Low-grade fever. • Constipation or diarrhea. • Pale or yellowish skin. • Bleeding gums and mouth sores. • Shortness of breath, chest pain, rapid heartbeat. •Depression, confusion, poor memory, and dementia.
• Pernicious anemia is due to a lack of intrinsic factor. This is a substance made by cells in the stomach that makes it possible to absorb vitamin B-12. The reason for the lack of intrinsic factor is unknown. It may be an autoimmune reaction, a genetic factor, or both. • Other vitamin B-12 deficiency-caused anemias may be due to a variety of factors.
• Stomach surgery, stomach cancer, or gastritis. • Diabetes and autoimmune disorders. • Myxedema, Graves’ disease, other thyroid disorders. • Genetic factors, such as in people of Northern European ancestry. It is rare in blacks and Asians. • Family history of pernicious anemia. • Strict vegetarian diet or infants breast-fed by a mother on a strict vegetarian diet. • Lack of stomach acid in older adults. • Parasitic infections and intestinal diseases. • Drugs such as H2 blockers, proton pump inhibitors, colchicine, neomycin, and aminosalicylic acid. • Poor diet, such as due to alcoholism or aging.
Pernicious anemia cannot be prevented. In other anemias, avoiding risk factors, where possible, may help.
• For pernicious anemia, lifelong vitamin B-12 therapy will help symptoms and prevent complications. • For vitamin B-12 deficiency-caused anemia, vitamin B- 12 therapy or diet changes can prevent deficiency.
• Congestive heart failure. • Nerve damage that cannot be reversed. • Gastric cancer.
• Your health care provider will do a physical exam and ask questions about your symptoms and your diet. Medical tests include blood tests for vitamin B-12 levels, to check for antibodies to the intrinsic factor, and to measure the body’s ability to absorb vitamin B-12. • Treatment usually involves vitamin B-12 replacement. Lifetime treatment is needed for pernicious anemia. Some symptoms should start to clear up in a few days after treatment begins, while others may take several months. • Any underlying disorder (such as thyroid problems) will be treated also.
• Vitamin B-12 replacement will be prescribed. Some patients are given injections (they can be self-administered). For other patients (or in addition to injections), the vitamin may be taken by mouth or as a nasal gel. • Iron supplements may be prescribed. • Avoid taking high amounts of folic acid. It can mask the signs of vitamin B-12 deficiency.
Activity may be limited until symptoms improve.
• Eat a well-balanced diet. • People on strict vegetarian diets can change the diet or take vitamin B-12 supplements for life.
• You or a family member has symptoms of pernicious anemia. • Symptoms don’t start to improve with treatment.
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