Pernicious Anemia
What is this Condition?
This type of anemia is characterized by decreased ability to absorb vitamin B-12. The resulting vitamin B-12 deficiency causes serious neurologic and gastrointestinal abnormalities as well as destruction of red blood cells. Untreated pernicious anemia may lead to permanent neurologic disability and death.
Pernicious anemia primarily affects people of northern European ancestry. In the United States, it’s most common in New England and the Great Lakes regions, where many such people have settled. It’s rare in children, Blacks, and Asians. The disorder typically begins between ages 50 and 60; its incidence increases with age.
What Causes it?
The tendency of this disorder to run in families suggests a genetic predisposition. Pernicious anemia is common in people with certain immune disorders.
What are its Symptoms?
Pernicious anemia usually begins gradually but eventually causes these three symptoms: weakness, sore tongue, and numbness and tingling in the arms and legs. The lips, gums, and tongue appear bloodless. Excessive bilirubin in the blood, which is due to destruction of red blood cells, may tint the eyes yellow and cause pale to bright yellow skin. In addition, the person may become highly susceptible to infection, especially of the genitourinary tract.
Other symptoms of pernicious anemia include the following:
• Digestive tract: disturbed digestion; nausea; vomiting; loss of appetite; weight loss; gas, diarrhea, and constipation; bleeding gums and tongue inflammation.
• Nervous system: neuritis; weakness, numbness, and tingling in the arms and legs; disturbed position sense; poor coordination; ataxia; impaired fine finger movement; light-headedness; double or blurred vision; altered sense of taste; ringing in the ears; optic muscle wasting; loss of bowel and bladder control; and (in males) impotence.
• Heart and circulation: weakness, fatigue, and light-headedness due to low hemoglobin levels. The heart works faster to compensate, resulting in palpitations, wide pulse pressure, shortness of breath, difficulty breathing while lying down, faster heart rate, premature beats and, eventually, congestive heart failure.
How is it Diagnosed?
A positive family history and results of blood studies, bone marrow aspiration, gastric analysis, and the Schilling test establish the diagnosis. Lab tests must rule out other anemias with similar symptoms, such as folic acid deficiency anemia, because treatment differs. The diagnosis must also rule out vitamin B-12 deficiency due to malabsorption caused by stomach disorders, gastric surgery, radiation, or drug therapy.
How is it Treated?
The doctor can prescribe early vitamin B12 replacement to reverse pernicious anemia, minimize complications, and possibly prevent permanent nervous system damage. The vitamin is given by injection into the muscle, skin, or veins. An initial high dose of parenteral vitamin B12 causes rapid regeneration of red blood cells. Within 2 weeks, the persons condition should markedly improve. Because rapid cell regeneration increases iron and folate requirements, these compounds are given to prevent iron deficiency anemia.
After the person’s condition improves, the vitamin B-12 dosage can be decreased to maintenance levels and given monthly. Because such injections must be continued for life, the person should learn how to give himself or herself the vitamin.
Tagged under:ataxia, Blood Disorders, numbness and tingling, pernicious anemia, red blood cells, vitamin b 12 vitamin b 12 deficiency