Dr. M.J. Bazos, MD
Patient Handout
ANEMIA,
PERNICIOUS
About Your
Diagnosis
Pernicious anemia is deficiency of red blood
cells and hemoglobin that results from a deficiency or abnormal absorption of
cobalamin (vitamin
B12).
This vitamin is essential for normal growth and development of red blood cells,
other blood cells, and cells of the nervous system. Insufficient intake of
vitamin B12
rarely causes anemia. Most frequently absence
of a specific protein, intrinsic factor, necessary for absorption of vitamin
B12
causes pernicious anemia. This occurs when the
immune system attacks the cells of the stomach lining and prevents them from
producing intrinsic factor. Other mechanisms include absence of the stomach or
small intestine after an operation, tapeworm infestation, or tropical sprue.
Pernicious anemia is rare. Both sexes are affected equally. This form of anemia
rarely occurs before 30 years of age. It is more common among persons of
northern European descent. The diagnosis of pernicious is made by means of
microscopic examination of the blood and measurement of vitamin
B12
and the products of its breakdown in the
blood. Special tests may be needed to observe abnormal absorption of the vitamin
(Schilling test) and document the presence of specific antibodies.
Supplementation of vitamin B12
leads to full correction of anemia. Patients
with deficient absorption of the vitamin need long-term supplementation.
Living With Your
Diagnosis
Anemia becomes apparent as
fatigue and poor exercise tolerance. In severe cases anemia can cause chest
pain, shortness of breath, and a rapid heart beat. Patients with pernicious
anemia, however, almost never need blood transfusions. Deficiency of vitamin
B12
can produce decreased sensation and numbness
in the feet and hands. Severe deficiency can cause severe neurologic deficits,
such as confusion and disorientation, but this is
rare.
Treatment
Therapy
for pernicious anemia is administration of vitamin
B12
as injections under the skin or into the
muscle. Initial treatment involves daily injections followed by weekly and
eventually monthly injections. Improvement in the sense of well-being occurs in
a matter of days. It takes 4 to 8 weeks to demonstrate an increase in hemoglobin
concentration. Treatment is lifelong. Patients with insufficient intake can take
oral vitamin
B12.
There are no known side effects or complications of taking vitamin
B12.
Vitamin B12
is also available as a gel solution for
intranasal administration (Nascobal), which is administered via a metered dose
nasal inhaler once weekly in place of monthly injections. Intranasal
administration for maintenance therapy of pernicious anemia should be used only
after the initial deficiency has been corrected with vitamin
B12
injections. Medical supervision is necessary
for the initial treatment with vitamin
B12,
because lowering of blood potassium level may occur. A simple blood test can
determine this. Potassium taken as a
pill
corrects this temporary problem.
The
DOs
• Continue treatment on a
monthly basis (if injections are used), even if the anemia is corrected.
Discontinuation of treatment leads to recurrence of anemia and all the
symptoms.
• Follow the schedule of
vitamin B12
injections recommended by your
physician.
• Discuss a
supplementation schedule with your physician if you are
pregnant.
• Eat a well-balanced diet,
rich in folic acid (another vitamin important for the blood cells) and other
essential nutrients.
• Supplement
your diet with oral vitamins if you eat a special diet, such as a vegetarian,
especially vegan, diet.
The
DON’Ts