6/24/2016

PerniciousAnemiaOverviewNYTimesHealth

PerniciousAnemiaOverview
PerniciousanemiaisadecreaseinredbloodcellsthatoccurswhenyourintestinescannotproperlyabsorbvitaminB12.
Seealso:
Megaloblasticanemia
Anemia
ReferencefromA.D.A.M.
ALTERNATIVENAMES

MacrocyticachylicanemiaCongenitalperniciousanemiaJuvenileperniciousanemiaVitaminB12deficiency(malabsorption)
CAUSES

PerniciousanemiaisatypeofvitaminB12anemia.ThebodyneedsvitaminB12tomakeredbloodcells.Yougetthisvitaminfromeatingfoodssuchasmeat,
poultry,shellfish,eggs,anddairyproducts.
Aspecialprotein,calledintrinsicfactor,helpsyourintestinesabsorbvitaminB12.Thisproteinisreleasedbycellsinthestomach.Whenthestomachdoesnot
makeenoughintrinsicfactor,theintestinecannotproperlyabsorbvitaminB12.
Commoncausesofperniciousanemiainclude:
Weakenedstomachlining(atrophicgastritis)
Anautoimmuneconditioninwhichthebody'simmunesystemattacksintrinsicfactorproteinorthecellsthatmakeit.
Veryrarely,perniciousanemiaispasseddownthroughfamilies.Thisiscalledcongenitalperniciousanemia.Babieswiththistypeofanemiadonotmake
enoughintrinsicfactororcannotproperlyabsorbvitaminB12inthesmallintestine.
Inadults,symptomsofperniciousanemiaareusuallynotseenuntilafterage30.Theaverageageofdiagnosisisage60.
Youaremorelikelytogetthisdiseaseifyou:
ScandinavianorNorthernEuropean
Haveafamilyhistoryofthecondition
Certaindiseasescanalsoraiseyourrisk.Theyinclude:
Addison'sdisease
Chronicthyroiditis
Gravesdisease
Hypoparathyroidism
Hypopituitarism
Myastheniagravis
Secondaryamenorrhea
Type1diabetes
Testiculardysfunction
Vitiligo
ForinformationonothercausesoflowvitaminB12levels,see:AnemiaB12deficiency
SYMPTOMS

Somepeopledonothavesymptoms.Symptomsmaybemild.
Theycaninclude:
Diarrheaorconstipation
Fatigue,lackofenergy,orlightheadednesswhenstandinguporwithexertion
Lossofappetite
Paleskin
Problemsconcentrating
Shortnessofbreath,mostlyduringexercise
Swollen,redtongueorbleedinggums
IfyouhavelowvitaminB12levelsforalongtime,youcanhavenervoussystemdamage.Symptomscaninclude:
Confusion
Depression
Lossofbalance
Numbnessandtinglinginthehandsandfeet
EXAMSANDTESTS

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PerniciousAnemiaOverviewNYTimesHealth

Thedoctorornursewillperformaphysicalexam.Teststhatmaybedoneinclude:
Bonemarrowexamination(onlyneededifdiagnosisisunclear)
Completebloodcount(CBC)
Reticulocytecount
Schillingtest
LDH
Methylmalonicacid(MMA)level
VitaminB12level
Thislistisnotallinclusive.
Perniciousanemiamayalsoaffecttheresultsofthefollowingtests:
Bilirubin
Cholesteroltest
Gastrin
Leukocytealkalinephosphatase
Peripheralsmear
TIBC
AwomanwithlowB12levelsmayhaveafalsepositivePapsmear.That'sbecauseavitaminB12deficiencyaffectsthecellscertaincells,calledepithelial
cells,look.
TREATMENT

ThegoaloftreatmentistoincreaseyourvitaminB12levels.
TreatmentinvolvesashotofvitaminB12onceamonth.PersonswithseverelylowlevelsofB12mayneedmoreshotsinthebeginning.
SomepatientsmayalsoneedtotakevitaminB12supplementsbymouth.Forsomepeople,highdosevitaminB12tabletstakenbymouthworkwell,andshots
arenotneeded.
AcertaintypeofvitaminB12maybegiventhroughthenose.
Yourdoctorornursewillalsorecommendeatingawellbalanceddiet.
OUTLOOK(PROGNOSIS)

Patientsusuallydowellwithtreatment.
Itisimportanttostarttreatmentearly.Nervedamagecanbepermanentiftreatmentdoesnotstartwithin6monthsofsymptoms.
POSSIBLECOMPLICATIONS

Peoplewithperniciousanemiamayhavegastricpolyps,andaremorelikelytodevelopgastriccancerandgastriccarcinoidtumors.
Brainandnervoussystemproblemsmaycontinueorbepermanentiftreatmentisdelayed.
WHENTOCONTACTAMEDICALPROFESSIONAL

CallyourhealthcareproviderifyouhavesymptomsofvitaminB12deficiency.
PREVENTION

ThereisnoknownwaytopreventthistypeofvitaminB12anemia.However,earlydetectionandtreatmentcanhelpreducecomplications.
REFERENCES

AntonyAC.Megaloblasticanemias.In:HoffmanR,BenzEJ,ShattilSS,etal.,eds.Hematology:BasicPrinciplesandPractice.5thed.Philadelphia,Pa:Elsevier
ChurchillLivingstone2008:chap39.
AntonyAC.Megaloblasticanemias.In:GoldmanL,SchaferAI,eds.CecilMedicine.24thed.Philadelphia,Pa:SaundersElsevier2011:chap167.
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