Diseases and Disorders

What is a Pernicious Anaemia? A Type of Vitamin B12 Anaemia

Anaemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anaemia. Pernicious anaemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12.

How to know if you are anaemic?

  • Do you feel tired and listless? 
  • Do you find your mind drifting during the day? 
  • Do you get dizzy or short of breath whenever you climb the stairs? 

There are a few possible reasons for the way you feel, but you could have anaemia. You could even have anaemia without noticing any symptoms at all. Anaemia is a problem with haemoglobin, a substance in red blood cells that carries oxygen throughout your body. Without enough haemoglobin, your heart and other organs can’t get the oxygen they need to work. When your organs slow down, you slow down, and you start feeling tired and listless. 

Many different health conditions can cause anaemia, from heavy blood loss during a woman’s period, to pregnancy, to an underactive thyroid gland. Healthy red blood cells are made in your bone marrow, the soft tissue in the middle of your bones. Any disease that damages blood marrow, such as lymphoma or leukaemia, can also affect your red blood cell production. Anaemia can also be caused by an immune system problem that damages red blood cells or surgery to the stomach or intestines. 

How do you know if you have anaemia? You may feel tired, dizzy, and have trouble concentrating. You may get sick more often. People with anaemia often complain of chest pain, headaches, or shortness of breath. Your skin might look pale like you haven’t seen the sun for months. Because these can also be symptoms of other conditions, your doctor will confirm that you have anaemia by taking a blood test to check your red blood cell count and haemoglobin level. Blood tests can also look for problems that may be causing your anaemia, such as a vitamin or iron deficiency. 

If you are anaemic, it’s very important to treat it. When your body isn’t getting enough oxygen, it can starve vital organs like your heart. This can lead to a heart attack. How you treat anaemia depends on the cause. If the problem is with your bone marrow, you may take a medicine called erythropoietin, which will help your bone marrow make more red blood cells. 

If the problem is a vitamin or mineral deficiency, your doctor may prescribe iron, vitamin B12, or folic acid supplements. Or, you may need a blood transfusion to replace damaged red blood cells with healthy ones. How well you do depends on what’s causing your anaemia. Call your doctor if you have any symptoms like fatigue or shortness of breath. Once your doctor can find and treat the cause of your anaemia, you should have more energy and start feeling like your old self again.

Causes of Pernicious Anaemia

Pernicious anaemia is a type of vitamin B12 anaemia. The body needs vitamin B12 to make red blood cells. You get this vitamin from eating foods such as meat, poultry, shellfish, eggs, and dairy products.

A special protein, called intrinsic factor (IF), binds vitamin B12 so that it can be absorbed in the intestines. This protein is released by cells in the stomach. When the stomach does not make enough intrinsic factors, the intestine cannot properly absorb vitamin B12.

Common causes of pernicious anaemia include:

  • Weakened stomach lining (atrophic gastritis)
  • An autoimmune condition in which the body’s immune system attacks the actual intrinsic factor protein or the cells in the lining of your stomach that make it.

In rare cases, pernicious anaemia is passed down through families. This is called congenital pernicious anaemia. Babies with this type of anaemia do not make enough intrinsic factors. Or they cannot properly absorb vitamin B12 in the small intestine.

In adults, symptoms of pernicious anaemia are usually not seen until after age 30. The average age of diagnosis is age 60.

You are more likely to develop this disease if you:

  • Are Scandinavian or Northern European
  • Have a family history of the condition

Certain diseases can also raise your risk. They include:

  • Addison disease
  • Graves disease
  • Hypoparathyroidism
  • Hypothyroidism
  • Myasthenia gravis
  • Loss of normal function of ovaries before 40 years of age (primary ovarian failure)
  • Type 1 diabetes
  • Testicular dysfunction
  • Vitiligo
  • Sjogren syndrome
  • Hashimoto disease
  • Celiac disease

Pernicious anaemia can also occur after gastric bypass surgery.

Symptoms of Pernicious Anaemia

Some people do not have symptoms. Symptoms may be mild.

They can include:

  • Diarrhoea or constipation
  • Nausea
  • Vomiting
  • Fatigue, lack of energy, or lightheadedness when standing up or with exertion
  • Loss of appetite
  • Pale skin (mild jaundice)
  • Shortness of breath, mostly during exercise
  • Heartburn
  • Swollen, red tongue or bleeding gums

If you have a low vitamin B12 level for a long time, you can have nervous system damage. Symptoms can include:

  • Confusion
  • Short-term memory loss
  • Depression
  • Loss of balance
  • Numbness and tingling in the hands and feet
  • Problems concentrating
  • Irritability
  • Hallucinations
  • Delusions
  • Optic nerve atrophy

Tests for Pernicious Anaemia

The laboratory test provider will perform a physical exam. Tests that may be done include:

  • Complete blood count (CBC)
  • Reticulocyte count
  • Lactate dehydrogenase (LDH) level
  • Serum bilirubin
  • Methylmalonic acid (MMA) level
  • Homocysteine level (an amino acid found in the blood)
  • Vitamin B12 level
  • Levels of antibodies against IF or the cells that make IF

Treatment for Pernicious Anaemia

The goal of treatment is to increase your vitamin B12 level:

  • Treatment involves a shot of vitamin B12 once a month. People with severely low levels of B12 may need more shots in the beginning.
  • Some people may be adequately treated by taking large doses of vitamin B12 supplements by mouth.
  • A certain type of vitamin B12 may be given through the nose.

Possible Complications of Pernicious Anaemia

  1. People with pernicious anaemia may have gastric polyps.
  2. They are also more likely to develop gastric cancer and gastric carcinoid tumours.
  3. People with pernicious anaemia are more likely to have fractures of the back, upper leg, and upper forearm.
  4. Brain and nervous system problems may continue or be permanent if treatment is delayed.
  5. A woman with a low B12 level may have a false positive Pap smear. This is because vitamin B12 deficiency affects the way certain cells (epithelial cells) in the cervix look.

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