Diagnostics | Pernicious anemia

Diagnostics

For diagnostics, a blood sample is first taken and the values of the red blood cells, vitamin B12 and intrinsic factor are determined. For further diagnosis and differentiation, a bone marrow sample can also help here. Alcohol abuse and malnutrition should also be excluded as causes. The search for antibodies is indicated if the cause is suspected to be an autoimmune reaction against the cells that form the intrinsic factor essential for absorption.

Laboratory parameters

A megaloblastic anaemia is the umbrella term for various anaemias, including pernicious anaemia. The megaloblastic anemias are characterized by too large cells with too high iron or hemoglobin content, they are also called hyperchrome macrocytic. The blood levels of MCV and MCH are elevated.

Since DNA synthesis is affected, there is often a simultaneous disturbance in the formation of white blood cells (leukocytopenia) and blood platelets (thrombocytopenia). Due to the increased destruction of red blood cells, an increase in the laboratory parameter LDH is also observed. By this I mean an enzyme which is found in the cytoplasm of almost all cells.

As a result of the increased death, the components of blood degradation are altered. For example, there is an increase in indirect bilirubin and a decrease in haptoglobin. In addition, one finds a decreased serum concentration of vitamins. After blood collection, care must be taken that the samples are stored and transported away from light, as light irradiation leads to false low values.

Therapy

In the treatment of anemia caused by disturbances in blood formation, it is of crucial importance to start the treatment as early as possible. The earlier the start of therapy, the higher the probability that the symptoms, especially the neurological symptoms, will completely disappear. The highest principle is the substitution of the missing vitamin.

Vitamin B12 is replaced by injections into the muscle or, in mild cases, by taking vitamin B12 preparations. In pernicious anemia, this substitution is necessary for life. Daily injections are necessary until the blood count has normalized, after which only one maintenance dose every 3 months is necessary.An accompanying substitution of iron is useful. In contrast, the substitution of folic acid can be discontinued after initial daily oral administration as soon as the deficiency is corrected.