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Pernicious Anemia
(Juvenile Pernicious Anemia, Congenital Pernicious Anemia)

Definition:
Pernicious anemia develops when the body is unable to absorb the vitamin B-12 it needs from food because of a lack of a protein, called intrinsic factor, produced by the stomach. Intrinsic factor is required for absorption of vitamin B-12. Pernicious anemia is often associated with an autoimmune-mediated attack of parietal cells of the stomach and/or intrinsic factor. Anemia is the insufficient delivery of oxygen by red blood cells from the lungs to the cells of the body. The sooner pernicious anemia is treated, the better the outcome. If you suspect you have this condition, contact your doctor.

Causes:
There are many possible causes of pernicious anemia. Some are listed below.
  • Atrophic gastritis (inflammation of the stomach)
  • Removal of all or part of the stomach
  • Immune system reaction to:
    • Intrinsic factor–a protein necessary for vitamin B-12 absorption
    • Cells that produce both intrinsic factor and hydrochloric acid in the stomach
  • Genetics
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of developing pernicious anemia:

  • Autoimmune disorders and other conditions, such as:
    • Type 1 diabetes
    • Addison’s disease
    • Graves’ disease
    • Myasthenia gravis
    • Secondary amenorrhea
    • Hypoparathyroidism
    • Hypopituitarism
    • Testicular dysfunction
    • Chronic thyroiditis
    • Vitiligo
    • Idiopathic adrenocortical insufficiency
  • Ancestry: northern European or Scandinavian
  • Age: over 50 years old
Symptoms:
The symptoms of pernicious anemia can vary from person-to-person. Symptoms may change or worsen over time. If you experience any of these symptoms do not assume it is due to pernicious anemia. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician. Symptoms can include:
  • Sensation of pins and needles in feet or hands
  • Alternating constipation and diarrhea
  • Stinging sensation on the tongue, or a smooth red tongue
  • Substantial weight loss
  • Inability to distinguish the colors yellow and blue
  • Tiredness
  • Paleness
  • Loss of hunger
  • Altered sense of taste
  • Confusion
  • Depression
  • Impaired sense of balance, especially in the dark
  • Ringing in the ears
  • Cracked lips
  • Fever
  • Inability to sense vibrations in feet or legs
  • Dizziness when changing to standing position
  • Rapid heart rate
Diagnosis:
Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include the following:

  • Complete Blood Count (CBC)–a count of the number of red and white blood cells in a blood sample
  • Vitamin B-12 Level–a test that measures the amount of vitamin B-12 in the blood
  • Methylmalonic Acid (MMA) Level–a measurement of the amount of methylmalonic acid in the blood; this test determines whether a vitamin B-12 deficiency exists
  • Homocysteine Level–a test that measures the amount of homocysteine in the blood (homocysteine is a building block of protein)
  • Schilling Test–a test in which a harmless amount of radiation is used to assess the amount of stored vitamin B-12 (rarely used)
  • Red Blood Cell Folate Level–a measurement of the amount of a B vitamin called folate
  • Intrinsic Factor Assay–a measurement of the amount of a protein called intrinsic factor normally produced by the stomach
  • Bone Marrow Staining–a test that shows whether an iron deficiency exists
Treatment:
Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Vitamin B-12 Injections
The treatment consists of injections of vitamin B-12 into a muscle. These injections are necessary because the intestines cannot absorb enough vitamin B-12 without an adequate supply of intrinsic factor from the stomach.

Oral Vitamin B-12 Supplement
Some doctors advise elderly patients to take oral B-12 supplements alone or in addition to injections of vitamin B-12.

Intranasal Vitamin B-12
The doctor gives the patient a supplement of vitamin B-12 that is placed in the nose.

Oral Iron Therapy
The physician will recommend this treatment when an iron deficiency exists. In this case, the doctor will tell the patient to take iron supplements before treating with vitamin B-12.

Prevention:
To help reduce your chances of getting pernicious anemia, take the following steps:
  • Avoid over-consuming alcohol.
  • Have your doctor check you for signs of iron deficiency.
  • Undergo testing if your doctor suspects you are infected with the bacterium Helicobacter pylori.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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