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Pernicious Anemia by Monique Kahn, MS, RD

Definition

Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low the body does not get enough oxygen. This can cause symptoms such as fatigue, pale skin, or irregular heartbeat.

Pernicious anemia is associated with problems absorbing vitamin B12. This vitamin is needed to make healthy RBCs. Over time the low vitamin B12 levels will reduce the number of new RBCs. The sooner pernicious anemia is treated, the better the outcome. If you suspect you have this condition, contact your doctor.

Red Blood Cells

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 B12 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 B12 level—a test that measures the amount of vitamin B12 in the blood
Methylmalonic acid (MMA) level—a measurement of the amount of methylmalonic acid in the blood; this test determines whether a vitamin B12 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 B12 (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 B12 Injections

The treatment consists of injections of vitamin B12 into a muscle. These injections are necessary because the intestines cannot absorb enough vitamin B12 without an adequate supply of intrinsic factor from the stomach.

Oral Vitamin B12 Supplement

If you are elderly, your doctor may advise you to take oral B12 supplements alone or in addition to injections of vitamin B12.

Intranasal Vitamin B12

Your doctor may give you a supplement of vitamin B12 that is placed in the nose.

Oral Iron Therapy

This treatment is recommended when an iron deficiency exists. In this case, the doctor will tell you to take iron supplements before treating with vitamin B12.

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 .

RESOURCES:

Family Doctor http://familydoctor.org/
National Institutes of Health Office of Dietary Supplements http://ods.od.nih.gov/index.aspx/

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca/index-eng.php/
Public Health Agency of Canada http://www.phac-aspc.gc.ca/chn-rcs/index-eng.php/

References:

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy . 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999.
Beers MH, Porter RS, Jones TV, eds. The Merck Manual of Diagnosis and Therapy . 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006.
DynaMed Editorial Team. Pernicioius anemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 27, 2010. Accessed November 10, 2010.
Escott-Stump S. Nutrition and Diagnosis-Related Care . 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s Principles of Internal Medicine . 16th ed. New York, NY: McGraw-Hill Companies, Inc; 2005.
Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition and Diet Therapy . 10th ed. Philadelphia, PA: WB Saunders Company; 2000.
Mahan LK, Escott-Stump S, eds. Krause’s Food, Nutrition and Diet Therapy . 11th ed. Philadelphia, PA: WB Saunders Company; 2003.
Morrison G, Hark L, eds. Medical Nutrition and Disease . 2nd ed. Malden, MA: Blackwell Science; 1999.
Whitney EN, Rolfes SR. Understanding Nutrition . 8th ed. Belmont, CA: West/Wadsworth; 1999.
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Last reviewed September 2012 by Kari Kassir, MD

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