Anemia due to vitamin B12 deficiency is characterized by a lowered serum hemoglobin content, which in most cases is due to impaired absorption of vitamin B12 in the gastrointestinal tract. Elderly people in particular often suffer from vitamin B12 deficiency and are at risk with regard to vitamin deficiency anemia.
What is anemia caused by vitamin B12 deficiency?
Anemia due to vitamin B12 deficiency is a deficiency of hemoglobin, the red blood pigment of erythrocytes (red blood cells) that play an essential role in oxygen transport, caused by a lack of vitamin B12. Vitamin B12 is an essential component for the synthesis of chromosomes (the genetic material of cells). During cell division, the chromosomes of a cell must be duplicated. If there is a deficiency of vitamin B12, the cell division process is disturbed, so that the cell division and maturation of those cells in the bone marrow from which the erythrocytes are formed is also slowed down. The proportion of red blood cells in the serum is correspondingly reduced, and in the long term anemia results from vitamin B12 deficiency. If left untreated, anemia slowly leads to frequent feelings of weakness and fatigue, shortness of breath on exertion, palpitations, elevated pulse, neurological symptoms, and impaired concentration and pale skin.
Causes
In most cases, anemia due to vitamin B12 deficiency is due to impaired processing or absorption of the vitamin in the small intestine. Vitamin B12 can only be absorbed in the small intestine if it forms a complex with a specific protein molecule produced by the occupant cells of the gastric mucosa, called intrinsic factor. If this intrinsic factor is missing, for example as a result of pernicious anemia, an autoimmune disease in which the body’s own antibodies are directed against the gastric mucosal cells, the vitamin cannot be absorbed and anemia results from vitamin B12 deficiency. In addition, infections with intestinal parasites (including fish tapeworm), which cause an increased vitamin B12 requirement, intestinal diseases such as Crohn’s disease, and partial removal of the small intestine or stomach can lead to anemia. In contrast, anemia due to vitamin B12 deficiency is rarely due to malnutrition, except in the case of a vegan diet.
Symptoms, complaints, and signs
Anemia due to vitamin B12 deficiency is a very serious condition that, if left untreated, very often leads to death. So-called vitamin B12 deficiency anemia or pernicious anemia is characterized by many different symptoms. Typical symptoms attributable to the blood deficiency are chronic fatigue, severe drop in performance, increased heart rate, pale skin and tendency to collapse. Red blood cells are larger than normal but reduced in number. In addition to these symptoms, there is often a burning tongue, aphthae on the tongue and oral mucosa, rhagades of the corners of the mouth, and digestive disorders. Infants and young children often suffer from severe developmental disorders. In infants, vitamin B12 deficiency becomes noticeable through frequent crying (cry baby). Furthermore, stomach pain occurs as part of the autoimmune gastritis that causes vitamin B12 deficiency. In addition, anemia in vitamin B12 deficiency is also accompanied by neurological symptoms. Thus, neuropathies occur, which are characterized by tingling, insensitivity, numbness of the skin, hands and feet that fall asleep, coordination disorders, and gait unsteadiness. In extreme cases, severe paralysis and severe pain can also occur. Affected individuals are generally very sensitive to pain anyway. The nerve damage becomes irreversible if treatment is not given in time. Furthermore, psychological symptoms such as depression, declining memory, concentration disorders, dementia, psychoses or schizophrenia may also occur. Patients with vitamin B12 deficiency anemia are also thought to be at increased risk for cardiovascular disease and cancer.
Diagnosis and course
Anemia due to vitamin B12 deficiency is diagnosed by blood analysis. Decreased vitamin B12 levels in blood serum, decreased reticulocyte levels (precursor of erythrocytes), and enlarged erythrocytes with increased hemoglobin content indicate anemia. Furthermore, other examinations are used for differential diagnosis.For example, the Schilling test can be used to detect impaired absorption of vitamin B12. A stool analysis can detect any parasite infestation that may be present. If the anemia is caused by pernicious anemia, antibodies against the gastric mucosal cells can be detected, while a gastroscopy provides information about the characteristic impairments. The course and prognosis of anemia due to vitamin B12 deficiency depend largely on the underlying cause. If left untreated, anemia leads to neurologic damage that is often irreversible.
Complications
Without treatment, anemia from vitamin B12 deficiency can lead to cardiovascular complications: In the long term, increased stress on the heart is possible. Reduced oxygen transport also increases the risk of circulatory collapse. The latter can lead to further complications – for example, falls that may result in injuries. Vitamin B12 deficiency in itself can also cause complications. Without treatment, permanent neurological disorders are also possible. Adequate compensation for the deficiency should therefore be provided as early as possible. Neurological complaints manifest themselves in vitamin B12 deficiency, for example, as a numb feeling or tingling in the arms or legs. In addition to the general symptoms of anemia, other signs may occur in vitamin B12 anemia. These include fatigue, pallor, indigestion, feeling weak, bleeding gums and lightheadedness. In addition, the rate of heartbeat and breathing may increase. Psychological complications include memory impairment, confusion, concentration problems, and depressed mood. In some cases, psychotic perceptions in the form of hallucinations, mind wandering or similar symptoms are also possible. In addition, severe vitamin B12 deficiency may manifest itself with personality changes. In particular, the concentration and memory problems can cause a deterioration in professional or school performance. Overall, the various symptoms may also contribute to the affected person’s social withdrawal.
When should you see a doctor?
Abnormal sensations, such as cold sensations in the feet and hands, are common accompaniments of VB12 deficiency. Permanent tickling of the skin’s surface, consistent lack of concentration, and rampant daytime fatigue likewise occur with prolonged undersupply. These early warning signs are already sufficient reason to consult the family doctor. Anemia is itself considered a long-term sequela of a deficiency state. Even the mere suspicion in combination with pale skin, poor performance and attacks of dizziness justifies a more detailed examination of the vitamin B12 status. Likewise, anemia causes a massive deterioration in the general condition of already existing diseases due to the low oxygen supply in the bloodstream. Permanent inflammation of the gastric mucosa greatly decreases the ability of the gastrointestinal tract to absorb vitamin B12. In the case of regularly recurring abdominal pain, a review of the vitamin B12 supply is therefore advisable. Those affected often experience the decline in their performance as a gradual process. Even sufficient rest often does not bring any fundamental improvement. On the other hand, occasional fatigue without a continuous drop in fitness is usually not due to a shortfall in VB12 levels. Distinctive features such as unexplained pulse elevation, a red-colored tongue, nervous behavior, neurological symptoms, and signs of jaundice also provide important clues. Due to the numerous causes of anemia, a concrete analysis of the background can only be made by means of the blood serum. Postponing medical clarification is strongly discouraged. Anemia causes potentially life-threatening conditions if left untreated.
Treatment and therapy
In the case of anemia caused by vitamin B12 deficiency, therapeutic measures are always aimed in principle at eliminating the underlying disease as well as the vitamin deficiency by substitution therapy with synthetic vitamin B12. For this purpose, artificial vitamin B12 (1000 µg) must be injected into the muscle weekly during the first three weeks of therapy. Subsequently, the same amount of vitamin B12 is injected intramuscularly every 1 to 3 months.In addition, there is initially an increased need for iron for the formation of new red blood cells (erythrocytes), which should be covered by additional iron supplements. In the presence of an underlying disease such as pernicious anemia that cannot be cured, and after surgical removal of the stomach or parts of the small intestine, synthetic vitamin B12 must be injected for life in most cases to prevent anemia due to vitamin B12 deficiency. In rare cases (about two to five percent of those affected), late complications such as stomach or rectal carcinomas can occur. Therefore, even after successful completion of therapy for anemia, annual gastroscopies should be performed for control.
Outlook and prognosis
The prognosis for anemia due to vitamin B12 deficiency depends on the cause of the vitamin B12 deficiency. In most cases, there is gastritis caused by autoimmune reactions of the immune system against the gastric vestibular cells. The gastric vestibular cells are destroyed in the process. In this case it is a so-called pernicious anemia, which cannot be cured. The gastric vesicle cells produce the so-called intrinsic factor, which is responsible for the absorption of vitamin B12 in the intestine. Due to this autoimmune disease, the body can no longer absorb vitamin B12. Vitamin B12 must therefore either be administered in large quantities or injected. Without vitamin B12 administration, the prognosis of pernicious anemia is very poor. Fatigue, lack of concentration and poor performance increase more and more. At the same time, neurological deficits also increasingly occur. Without treatment, pernicious anemia eventually leads to death. In rarer cases, however, vitamin B12 deficiency has other causes. Among other things, this is the case with strict vegetarian diets, parasite infestation in the intestine, stomach reductions, bacterial load in the intestine, after intestinal surgery or malabsorption syndrome. In these cases, the appropriate treatment is given after determining the cause of the vitamin B12 deficiency. After eliminating the corresponding causes, such as a worm infestation, among others, the body can again be adequately supplied with vitamin B12, which stimulates blood formation.
Prevention
Some measures exist to prevent anemia caused by vitamin B12 deficiency. These include a varied diet, especially for people who eat a vegan diet. In addition, people who have undergone intestinal surgery or suffer from chronic inflammation of the gastrointestinal tract should have regular checks for anemia.
Follow-up
Severe anemia always belongs in the hands of an experienced physician. Anemia due to vitamin B12 deficiency is classified as the most severe form of vitamin B12-induced anemia. Because megaloblastic or pernicious anemia can be fatal without treatment, immediate treatment and lifelong follow-up are essential. As an initial measure, the cause of the vitamin B12 deficiency must be determined. In itself, the stores of this vitamin are filled for a relatively long time, but absorption disorders or surgical sequelae can change this negatively. Following the diagnostic phase, the permanent supply of vitamin B12 must be ensured. Subsequently, the blood values must be checked in regularly scheduled follow-up examinations. Follow-up care must be maintained throughout life, since the causes of the dramatic vitamin B12 deficiency usually cannot be eliminated. After acute treatment of the anemia, maintenance therapy with vitamin B12 is initiated. This measure must be monitored regularly. If the vitamin is administered by injection, follow-up must be done at least every two months. If high-dose vitamin B12 tablets of at least 5000 ug are taken, regular follow-up appointments must also be scheduled. Follow-up is important primarily because a recurrence of vitamin B12 deficiency can put the patient’s life in danger. Follow-up care ensures that the blood count returns to normal. However, a cure is not possible.
Here’s what you can do yourself
Anemia caused by vitamin B12 deficiency can be most easily corrected by changing the diet. Affected individuals can compensate for the deficiency primarily by eating animal products such as meat, eggs or offal.Fermented foods such as sauerkraut or beer also contain the B vitamin and quickly counteract mild anemia. In the case of severe anemia, additional dietary supplements containing vitamin B12, folic acid and iron can be used. Anyone suffering from anemia after an operation or a parasitic disease is advised to take bed rest. In addition, the deficiency can be counteracted, for example, by meat broth and drinking plenty of fluids. A diet plan helps to regulate vitamin B12 intake and prevent renewed anemia. Vegetarians and vegans in particular can avoid various deficiency symptoms by eating a balanced diet. Women with heavy menstruation should also act preventively and compensate for a possible loss of vitamin B12 and folic acid through a healthy diet and supplementary preparations. If the symptoms of anemia persist despite all measures, there may be another cause. In that case, a physician should diagnose the anemia and, if necessary, suggest appropriate therapy.
