Pernicious anemia Health Article

Symptoms

Too little vitamin B12 gradually causes nervous system (neurological) problems. The neurological effects may be seen before anemia is diagnosed.

Symptoms may include:

• Bleeding gums
• Diarrhea
• Fatigue
• Impaired sense of smell
• Loss of deep tendon reflexes
• Loss of appetite
• Pallor
• Personality or memory changes
• Positive Babinski's sign
• Rapid heart rate
• Shortness of breath
• Sore mouth
• Tingling and numbness of hands and feet
• Tongue problems
• Unsteady gait, especially in the dark

Signs and tests

Tests that may used to diagnose or monitor pernicious anemia include:

• Bone marrow examination (only needed if diagnosis is unclear)
• Complete blood count
• Measurement of serum holotranscobalamin II
• Reticulocyte count
• Schilling test
• Serum LDH
• Serum methylmalonic acid (MMA) level
• Serum vitamin B12 level

Pernicious anemia may also alter the results of the following tests:

• Bilirubin
• Cholesterol test
• Gastrin
• Leukocyte alkaline phosphatase
• Peripheral smear
• TIBC

Vitamin B12 deficiency affects the appearance of cells that form on the outer surface of the body and line inner passageways (epithelial cells). An untreated woman may have a false positive Pap smear.

Treatment

Monthly vitamin B12 injections are prescribed to correct the vitamin B12 deficiency. This therapy treats the anemia and may correct the neurological complications if taken early enough. In people with a severe deficiency, the injections are given more frequently at first.

Some doctors recommend that elderly patients with gastric atrophy take vitamin B12 supplements by mouth in addition to monthly injections.

There is also a preparation of vitamin B12 that may be given through the nose. For some people, taking vitamin B12 by mouth in a very high dose can also be an effective treatment.

A well-balanced diet is essential to provide other elements for healthy blood cell development, such as folic acid, iron, and vitamin C.

Expectations (prognosis)

The outcome is usually excellent with treatment.