Pernicious anemia: causes, symptoms and treatment & bull; hello healthy

Definition

What is pernicious anemia?

Pernicious anemia is a form of megaloblastic anemia that is triggered by a lack of vitamin B-12 intake to make red blood cells healthy.

Without enough vitamin B-12, the body will produce abnormally large red blood cells called macrocytes.

Due to their large size, these abnormal cells cannot leave the bone marrow, where red blood cells are made, so they cannot enter the bloodstream and spread to all body tissues. This is what causes the number of oxygen-carrying red blood cells in the bloodstream to decrease.

Quoted from the US Department of Health & Services website, the word "pernicious" from this type of anemia is taken from English absorption, namely pernicious which means bad or destructive. Pernicious anemia is called "devastating" because it was once thought to be fatal as a result of not providing adequate treatment.

If not treated properly, vitamin B-12 deficiency can cause some serious complications. However, pernicious anemia is now fairly easily treated with vitamin B-12 supplementation; either by injection or orally (oral medicine).

How common is this condition?

This type of anemia is a rare condition. The incidence rate is 0.1% in the general population and 1.9% in people over 60 years of age, according to the Journal of Blood Medicine.

However, this condition can be treated by reducing the risk factors. Talk to your doctor for more information.

Signs and Symptoms

What are the signs and symptoms of pernicious anemia?

Pernicious anemia is a disease that occurs slowly and is difficult to recognize at first.

Anemia of any type causes a variety of symptoms. Some of the signs and symptoms that can appear in pernicious anemia include:

• Weakness
• Headache
• Chest pain
• Weight loss

In rare cases, some people may have neurological signs and symptoms, such as:

• Unbalanced gait
• Spasticity, namely muscle stiffness and tension
• Peripheral neuropathy, which is numbness in the arms and legs
• Progressive injury of the spinal cord
• Memory loss

Other signs and symptoms of B-12 deficiency, which may be the same as pernicious anemia, include:

• Nausea and vomiting
• Dazed
• Depression
• Constipation (constipation)
• Loss of appetite
• Gastric acid

When should I see a doctor?

Early diagnosis and treatment can stop this condition from worsening and prevent other medical emergencies. For that, talk to your doctor immediately to prevent this serious condition.

If you have any signs or symptoms above or any other questions, please consult your doctor. Everyone's body is different. Always consult a doctor to treat your health condition.

Cause

What causes pernicious anemia?

Anemia can be caused by various things, depending on the type. Pernicious anemia is caused by a lack of intrinsic factors or other causes, such as infection, surgery, medications, or diet.

Lack of intrinsic factor

Intrinsic factor is a protein made in the stomach. This protein helps your body absorb vitamin B12. In some people, the autoimmune response causes intrinsic factor to decrease.

An autoimmune response occurs when the immune system makes antibodies (proteins) that attack and damage body tissues or cells.

In pernicious anemia, the body makes antibodies to attack and destroy parietal cells. These cells line the stomach and make intrinsic factor. The cause of this autoimmune response is still unknown.

As a result of antibody attack, the stomach stops producing intrinsic factor. Without intrinsic factor, the body is unable to channel vitamin B12 through the small intestine to absorb the vitamin. This condition triggers a deficiency of vitamin B12.

Intrinsic factor deficiency can also occur if you have had abdominal surgery before. This type of surgery reduces the number of parietal cells responsible for making intrinsic factor.

In rare cases, children are born with an inherited disorder that prevents the body from making intrinsic factor. This disorder is called congenital pernicious anemia.

Other causes

Apart from a lack of intrinsic factors, pernicious anemia is also caused by other factors. Malabsorption in the small intestine and intake of foods low in vitamin B12 can also cause pernicious anemia.

Malabsorption in the small intestine

Sometimes, pernicious anemia is caused by a disturbance in the absorption of vitamin B12 in the small intestine. This disorder is triggered by:

• Too many bad bacteria in the small intestine. This condition is a common cause of pernicious anemia in adults. The bacteria use vitamin B12 before the small intestine has finished absorbing it.
• Diseases that interfere with vitamin B12 absorption, such as celiac disease. Celiac disease is a genetic disorder in which the body cannot accept a protein called gluten. Apart from celiac disease, HIV disease and Crohn's disease (inflammatory bowel disease) can also interfere with vitamin B12 absorption.
• Certain drugs that affect bacterial growth or inhibit the absorption of vitamin B12 by the small intestine. These medications include antibiotics, seizure medications, and certain diabetes medications.
• Surgical removal of part or all of the small intestine.
• Tapeworm infection. Tapeworms take up vitamin B12 in the body. The trigger for this infection is the consumption of fish infected with tapeworms and the habit of eating undercooked fish.

A diet low in vitamin B12

Some people suffer from pernicious anemia because they don't have enough vitamin B12 in their diet. This cause of pernicious anemia is less common than other causes.

Food sources rich in vitamin B12 include:

• Breakfast cereals that contain vitamin B12
• Meats such as beef, liver, poultry and fish
• Eggs and dairy products (such as whole milk, yogurt, and cheese)
• Foods fortified with vitamin B12, such as soy based drinks and vegetarian burgers

Vegetarians who do not eat animals, dairy products, and vitamin B12 supplements are more likely to develop pernicious anemia.

Babies who are breastfed by vegetarian mothers are also at risk of developing pernicious anemia. These babies can show symptoms of anemia within a few months of being born.

The reason is, they do not have enough time to store vitamin B12 in their bodies. Generally, doctors will treat babies by providing vitamin B12 supplements.

Other groups, such as the elderly and alcoholics, may also be at risk for pernicious anemia. They may not be getting the proper nutrition in their diet.

Triggers

What puts me more at risk for pernicious anemia?

• Have a family history of this disease
• Is of Northern European or Scandinavian descent
• Have type 1 diabetes, an autoimmune condition, or certain intestinal diseases such as Crohn's disease
• Have had a part of the stomach or intestines removed
• Are over 60 years of age
• A strict vegetarian and do not take B-12 supplements
  

Complications

What are the complications that can arise from pernicious anemia?

Anemia can cause complications if left untreated. Pernicious anemia is a condition that can put extra weight on your heart. The reason is, the lack of blood makes the heart have to work harder to pump oxygenated blood throughout the body.

An overworked heart can cause the following conditions:

• Heart sounds (heart murmur) which is also a heart defect
• Fast heart rate
• Heart arrhythmias
• Enlarged heart
• Heart failure

Diagnosis

How is this condition diagnosed?

How to diagnose anemia, including pernicious anemia, with your medical history and that of your family. There is a possibility that anemia can be acquired from hereditary alias.

In addition, the doctor will perform a physical examination. During a physical exam, your doctor may check for pale or yellowish skin due to an enlarged liver. Your doctor may also listen to your heart to check whether it is beating regularly or not.

Your doctor can also check for signs of nerve damage. Its function is to see how well your muscles, eyes, senses and reflexes are working. Your doctor can ask questions or do tests to check your mental status, coordination, and walking ability.

Diagnostic tests and procedures

Here are some other tests that can be done to diagnose pernicious anemia:

1. Complete Blood Count

Complete blood count or complete count blood (CBC) is the first test your doctor will recommend to diagnose different types of anemia. This test aims to measure how much blood is in your body.

Later, a small amount of blood will be drawn from a vein (usually in your arm) using a needle.

The CBC checks the hemoglobin and hematocrit levels in you. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs throughout the body.

Meanwhile, the hematocrit is a measure of how much space red blood cells are taking up in your blood. A low hemoglobin or hematocrit level is a sign of anemia.

In certain ethnicities or races, the standard for the amount of blood in the body may vary. Later the doctor will explain the various methods and results of your blood test.

The CBC will also give a result of the number of red blood cells, white blood cells, and platelets in your blood. If there are abnormal results, there may be signs of anemia, blood disorders, infection, or other conditions.

A complete blood count can also see the mean corpuscular volume. This is a measure of the average size of your red blood cells. The corpuscular volume can be a clue as to what's causing your pernicious anemia.

2. Other blood tests

If the CBC results show that you have anemia, you may need other blood tests to find out the type and severity of anemia you have.

Reticulocyte count measure the number of pink blood cells in your blood. This test will evaluate the performance of your bone marrow in making red blood cells normally. Pernicious anemia patients have a relatively low reticulocyte count.

Serum folate, iron, and iron-binding tests can also help diagnose pernicious anemia or other types of anemia.

Another common test, the so-called Combined Binding Luminescence Test , sometimes giving inaccurate results. Scientists are still working on developing more sophisticated tests.

Your doctor may recommend other blood tests to check:

• Vitamin B12 levels. Low levels of vitamin B12 in the blood are a sign of pernicious anemia. However, the level of vitamin B12 in the blood may show inaccurate results due to interference from antibodies.
• Homocysteine ​​and methylmalonic acid (MMA) levels. High levels of MMA in your body are a sign of pernicious anemia.
• Intrinsic factor antibodies and parietal cell antibodies. These antibodies are also a sign of pernicious anemia.

3. Bone marrow test

A bone marrow test can show how healthy your bone marrow is making enough blood cells. The bone marrow test is divided into two, namely aspiration and biopsy.

For a bone marrow aspiration, the doctor will take a small amount of bone marrow fluid through a needle. The sample is examined under a microscope to check for damaged cells.

Meanwhile, a bone marrow biopsy can be done simultaneously or after an aspiration. For this test, the doctor will take a small amount of bone marrow tissue through a needle. The tissue sample is examined for the number and types of cells in the bone marrow.

In pernicious anemia, the size of the bone marrow cells that turn into blood cells becomes larger than normal.

Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How to treat pernicious anemia?

Treatment for anemia depends on the type. Pernicious anemia involves a 2 part process. First, the doctor will treat a vitamin B-12 deficiency and check for iron deficiency. Vitamin B-12 injections can be given daily or weekly until the B-12 levels return to normal (or nearly normal).

During the first few weeks of treatment, your doctor may recommend limiting physical activity. Once your vitamin B-12 levels are normal, you only need to get the injection once a month. You can give the injection yourself or have someone else inject it at home.

If your B-12 levels start to normalize, your doctor may also recommend taking a regular dose of B-12 supplements instead of injections. Supplements can come in the form of pills or sprays.

Prevention

What can I do to prevent and treat pernicious anemia?

Some of the things you do at home can help you treat and prevent pernicious anemia is that eating foods rich in vitamin B12 can prevent low levels of vitamin B12. Good sources of vitamin B12 include:

• Cereals with added vitamin B12
• Meats, such as beef, liver, poultry and fish
• Eggs and dairy products (such as milk, yogurt and cheese)
• Vitamin B12 fortified foods, such as soy-based drinks and veggie burgers)
• If you are a strict vegetarian, talk to your doctor about getting your vitamin B12 levels checked regularly.

If you have any questions, consult your doctor for the best solution to your problem.