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Pernicious anemia: causes, symptoms, diagnosis and treatment

Pernicious anemia: causes, symptoms, diagnosis and treatment

Pernicious anemia, also known as Biermer's anemia, is an autoimmune disease, hereditary, caused by deficient absorption of vitamin B12. It does not heal, but the administration of supplements with vitamin B12 all stop the symptoms and the progression of the disease. Untreated, the disease results in irreversible neurological complications. There is also a form of pernicious anemia that has food causes. Therefore, a diet rich in vitamin B12 can protect you from this serious form of anemia.

Why does anemia occur?

Red blood cells, produced in the bone marrow and responsible for transporting oxygen to vital tissues and organs, do not live longer than four months. In order to manufacture other red blood cells and thus maintain the health and balance of the body, the body needs iron, vitamin B12 and folic acid. The insufficiency of any of these elements will invariably lead to anemia. Iron deficiency will cause iron deficiency anemia, folic acid deficiency, folic acid deficiency anemia, and vitamin B12 malabsorption, pernicious anemia.

Harmful anemia, a consequence of autoimmune disease

In general, the term anemia refers to the decrease of hemoglobin and hematocrit values ​​below the minimum limit, corresponding to age and sex. Hemoglobin is the red pigment present in red blood cells (erythrocytes), which plays a role in the transport of oxygen and carbon dioxide. Hematocrit, on the other hand, is the blood test that measures the percentage of red blood cells in the blood. The hematocrit values ​​are expressed as a percentage.

In children between 2 and 15 years of age, the normal limits of hematocrit are between 36 - 39%. When the hematocrit value drops below 36%, we can talk about anemia.

In Biermer's disease, anemia is caused by vitamin B12 deficiency. Basically, the immune system produces antibodies that attack the parietal cells of the gastric mucosa, responsible for the secretion of hydrochloric acid and intrinsic factor, which helps the absorption of vitamin B12 from food. Antibody attack leads to atrophy of the gastric mucosa and, implicitly, to vitamin B12 deficiency and megaloblastic anemia. The atrophy of the gastric mucosa can be tested by endoscopes and biopsies, and the malabsorption of vitamin B12 by the Schilling test.

Vitamin B12 is found only in foods of animal origin such as meat, milk, eggs, cheese or fish. To absorb it, the stomach produces a substance called an intrinsic factor. It protects the vitamin from the destructive action of gastric juice. Without the intrinsic factor, vitamin B12 would be completely degraded. Therefore, if the stomach structure is affected, intrinsic factor secretion decreases and, with it, vitamin B12 absorption decreases.

Vitamin B12 deficiency is particularly dangerous, which can cause permanent neurological disorders. In severe cases, it can also cause inflammation of the nerves (neuritis) and even dementia (mental deterioration).

Causes of pernicious anemia

Biermer's anemia is transmitted hereditary. Prior to the discovery of the dietary cause and the treatment based on vitamin B12 supplements, this type of anemia was fatal, hence the term "pernicious anemia". The mechanism of the disease is similar to that of diabetes. In diabetes, the pancreas fails to produce enough insulin to keep blood sugar under control. Biemer anemia, on the other hand, is caused by the inability of gastric parietal cells to produce intrinsic factor, in sufficient quantities, to be able to absorb and metabolize vitamin B12.

Intrinsic factor insufficiency has been associated with other autoimmune diseases or chronic diseases, such as hypothyroidism, Addison's disease or gastric cancer.

Vitamin B12 deficiency can have causes other than autoimmune. Vegetarians, older people who have an inadequate diet, as well as alcoholics often face this deficiency. Another risk category is patients who have undergone gastric resection or have been diagnosed with celiac disease, Crohn's disease or bacterial or parasitic infections of the small intestine.

Diet plays an extremely important role in the prophylaxis of the disease. Specialized studies have shown that vegans often suffer from vitamin B12 deficiency, disorders of the stomach, intestine and pancreas, as well as various infections. Breastfed infants by vegetarian mothers are also affected by this vitamin B12 deficiency.

If you are a vegetarian and you are pregnant or breastfeeding, you will most likely need vitamin B12 supplements. The daily requirement of vitamin B12 is only 1 microgram. There is a reserve of vitamin B12 stored in the liver, but this amount, of 1,000 micrograms, is not enough for a period of 5 years.

Symptoms of pernicious anemia

Pernicious anemia manifests mainly in adults. The first signs may go unnoticed, the patient reaching the doctor because of symptoms that appear to indicate a heart or neurological condition.

General symptoms include:

- weight loss, caused by the lack of appetite (anorexia);

- a state of fatigue perma- nent;

- pallor;

- tachycardia;

- moderate fever.

Anemia Biemer also presents a series of specific manifestations, gastrointestinal, nervous or uro-genital in nature.

Gastrointestinal disorders include:

- plain language, without papillae, especially on the edges, observed in 50% of cases;

- burns located in the anterior third of the tongue or the red and painful tongue;

- constipation due to the modification of cells in the intestinal mucosa;

- anorexia, nausea, vomiting;

- flatulence;

- rarely, severe abdominal pain, associated with abdominal rigidity.

Nervous manifestations of Biemer anemia are common and include:

- paresthesias (tingling) caused by changes in the structure of nerve fibers, in the absence of sufficient intake of vitamin B12;

- muscle weakness;

- balance and coordination disorders, manifested by difficulties in walking;

- senile dementia in the case of the elderly;

- memory impairment, irritability, behavioral and personality changes;

- rarely, megaloblastic dementia characterized by aberrant ideas, hallucinations, schizoid or paranoid manifestations.

Manifestations from the urogenital sphere include:

- urinary retention caused by damage to the spinal nerves;

- predisposition to urinary tract infections.

Diagnosis in pernicious amenity

Pernicious anemia is a type of megaloblastic anemia. Megaloblasts are red blood cells or large red blood cells. Therefore, laboratory tests will show an increased red blood cell volume. In the case of anemia of autoimmune nature, endoscopies and biopsy of the gastric mucosa will reveal atrophy of the parietal cells.

The vitamin B12 deficiency is highlighted by the Shielling test. It has two distinct stages. In the first stage, vitamin B 12 is administered concurrently, both orally and intramuscularly:

- Orally, a microgram of vitamin B 12 is radiolabelled;
- 1000 micrograms of non-radioactive vitamin is administered intramuscularly.

Vitamin B12 administered orally will be eliminated to a greater extent by the urinary tract. The test is considered positive if the urinary elimination of the vitamin is less than 10% of the administered amount.

In Biermer's anemia, urinary excretion is usually less than 5%.

The second stage of the test The Shielling test is performed only if the first stage is positive. The patient is given oral intrinsic factor, along with the radioactive vitamin B12. If vitamin B 12 is low due to intrinsic factor deficiency, urinary excretion will improve.

Treatment of pernicious anemia

Depending on the cause of vitamin B12 deficiency, the treatment of pernicious anemia may vary. In general, we are talking about a substitution treatment, through the administration of vitamin B12 by injection. After the body's vitamin B12 reserves are restored, the symptoms disappear. Patients diagnosed with Biermer's anemia should undergo this lifelong substitution treatment, just like patients with diabetes.

Vitamin B12 injections are not toxic, except in rare cases of allergy. The specialist doctor will determine the optimal dose, the number of injections per week and the duration of a series of treatment. Some patients need weekly injections, in doses of 1,000 micrograms, for 6 weeks, followed by monthly injections.

Rarely do patients with pernicious anemia need blood transfusions. These are required only in case of severe congestive heart failure.

Eating harmful anemia can be resolved by changing the diet. The consumption of eggs, milk or meat is best indicated to remedy the vitamin B12 deficiency. In the case of vegetarians, it is necessary to take vitamin B12 orally. A tablet of 100 micrograms of vitamin B12 per week is an appropriate therapy.

Diagnosed in time, pernicious anemia allows you to live a normal life. On the contrary, delayed treatment can lead to irreversible neurological and mental injury.

Tags Anemia