Diseases of the blood system occupy a large part in medicine, along with diseases of the lymphatic system. Pernicious anemia occurs in both very young and adult people.
What is pernicious anemia?
Behind the term anemia is a blood disease, which is known as anemia even in colloquial use. This certainly stems from the fact that pernicious anemia is even visible externally if this condition is not treated. Pernicious anemia is only a disease of the blood-carrying system, which refers exclusively to the red blood cells. The disease is based on decreased maturation and storage of red blood pigment in the erythrocytes. If pernicious anemia is not adequately treated, the deficits that occur within the blood supply can be associated with a fatal outcome. Another name for pernicious anemia is Biermer’s disease.
Causes
The causes that can condition pernicious anemia and trigger a potentially very problematic course lie within such processes associated with the production of hemoglobin. The red blood pigment can be formed only if appropriate conditions exist. If the basics, such as vitamin B12, are missing, the synthesis of hemoglobin is only possible to a limited extent or not at all. If an undersupply of vitamin B12 occurs due to insufficient oral intake, this can lead to an impairment of the so-called hemoglobin synthesis. An insufficient supply of vitamin B12 can be caused by alcoholism, the ingestion of gastroprotective preparations, as well as by various diseases of the stomach and stomach cancer. Nitrous oxide also binds vitamin B12, and increased consumption of vitamin B12 due to pregnancy can also cause pernicious anemia.
Symptoms, complaints, and signs
Vitamin B12 deficiency and the resulting anemia form a variety of symptoms. Depending on the individual, these may occur in varying order and intensity. In general, patients are burdened by a continuous everyday fatigue with an accompanying loss of concentration. Even light, physical activities quickly have an exhausting effect. To compensate, normal rest periods are extended beyond the usual extent. At the same time, the circulatory system reacts sensitively to stress. Generalized restlessness with increased heart rate and visible pallor is evident. Rarely, dizziness is also present. Reddish discolored, smooth tongues are another feature of pernicious anemia. Discomfort in the digestive tract leads to abdominal pain and irregularities in digestion. In addition, VB12 deficiency promotes a number of psychological and neurological effects that appear in combination over the long term. For example, affected individuals develop depression, often become broody and experience anxiety. Abnormal sensations in the body are often described by individuals as formication and a furry feeling in various parts of the body. As a typical symptom, the person develops permanent irritability of the autonomic nervous system. Superficial muscle twitching without movement influence on the limbs occasionally makes itself felt. Theoretically, any part of the body can also be affected by numbness. A slowly increasing unsteadiness of gait due to coordination and balance problems makes everyday life more difficult for sufferers. In rare cases of pronounced anemia, paralysis symptoms occur. However, these are not irreversible and can be cured by appropriate therapy. Individuals experience the disease as a great, emotional burden until the cause is clarified, since symptoms individually have similarities with serious medical conditions.
Diagnosis and course
Pernicious anemia is manifested in the external appearance of affected individuals by a striking pallor of the skin as well as the mucous membranes. In addition, the patients’ performance capacity is typical due to anemia and an existing undersupply of oxygen. In addition, the course of pernicious anemia is characterized by neurological abnormalities such as circulatory disturbances with tingling and numbness in the extremities as well as disturbances of balance. In addition, the clinical picture of pernicious anemia worsens with disturbances in vision and depression, dementia-related deficits, and a yellowish-gray coloration of the skin.Other signs include abnormal smoothness of the tongue surface and an increasing tendency to circulatory collapse. These symptoms are important for diagnosis. This is supplemented in the case of pernicious anemia by an examination of the blood. Various tests also allow a clear differential diagnosis. In connection with the disease, they include checking the gastrin content in the blood plasma, the so-called shilling test, and the determination of specific antibodies.
Complications
Pernicious anemia can lead to various complications. In particular, most patients suffer from fatigue and feelings of weakness, which is due to the lack of oxygen within the body. Without proper treatment, there is a threat of serious problems with various organs. The heart is often affected by secondary symptoms of pernicious anemia. It has to work harder to provide oxygen to organs and tissues. Due to the unusually high output, symptoms such as heart murmurs, rapid heartbeat, cardiac arrhythmia or enlargement of the heart may occur. In the worst case, the affected person suffers from heart failure (cardiac insufficiency). The lack of cobalamin can also promote heart disease. Thus, the concentration of the chemical substance homocysteine increases in the body. In the further course, a heart attack or a stroke are possible. Nerve cells are also frequently affected by pernicious anemia. This is noticeable in neurological symptoms such as tingling in the limbs, numbness, difficulty walking, and loss of balance. Low cobalamin levels also affect the sense of taste, smell and vision. Occasionally, changes in the mind, such as memory loss or confusion, also become apparent.
When should you see a doctor?
Headaches, dizziness, or sensations of discomfort on the skin indicate vitamin B12 deficiency. A doctor should be consulted if pernicious anemia develops. The disease is manifested by incoordination, paralysis and other typical signs of anemia. If accompanying symptoms such as visual disturbances or depression occur, a visit to the doctor is recommended. The physician can make the diagnosis on the basis of the blood count or a gastroscopy and, if necessary, inject the sufferer directly with vitamin B12. After the injection is administered, the pernicious anemia should resolve without further complications. The usual follow-up visits will ensure that no side effects occur. The patient should see a nutritionist to avoid a recurrence of the deficiency. If the symptoms are based on a disease, further examinations and treatment must be carried out. For example, pernicious anemia can occur as a result of type A gastritis or parasitic disease. Alcoholism and cancer are also possible triggers that must be clarified by further investigations. Internists, gastroenterologists, cardiologists and other specialists are responsible, depending on the cause and type of symptoms. In addition, in the case of psychological triggers, a psychologist or a psychooncologist may be consulted if the pernicious anemia occurs in connection with cancer.
Treatment and therapy
Treatment of pernicious anemia is based mainly on compensating for the lack of vitamin B12 with medications. Basically, the hematopoietic organs of humans require a constant supply of this vitamin. This is the only way to enable hemoglobin synthesis. If pernicious anemia has occurred due to chronic inflammation of the gastric mucosa, vitamin B12 must be administered through the muscles, since the mucosa is unable to reabsorb this substance. If laboratory tests show an insufficient supply of iron, this deficiency must be additionally replenished in order to treat the disease. For better absorption of vitamin B12, appropriate treatment of gastroenteritis should be undertaken. This therapy is inevitable when the gastric mucosa is unable to metabolize the vitamin B12 absorbed through food.
Outlook and prognosis
The prognosis for pernicious anemia depends on the onset of therapy. Anemia treated early has the best chance of cure. The disease can be corrected by increased vitamin B12 intake, and symptoms subside.If treatment is too late, irreversible damage may remain. The prognosis is unfavorable; there is no longer any prospect of a complete cure at this point. Failure to diagnose in time and / or improper treatment can cause depression, fatigue, as well as neurological deficits. In the worst case, pernicious anemia develops in a life-threatening manner. For a favorable prognosis, the patient must take the disease seriously and follow the advice of his or her primary care physician. Pernicious anemia requires consistent use of vitamin supplements throughout life. The affected person can positively influence the prognosis by strictly adhering to the prescribed vitamin dosage. In order to counteract or prevent pernicious anemia, a specialist can regularly monitor the vitamin balance. This is done by taking blood samples. Changes in the blood count are detected in time and can be successfully treated at an early stage. In addition to vitamin tablets, changes in lifestyle and a healthier diet contribute to a favorable prognosis.
Prevention
Prophylaxis against pernicious anemia initially involves adequate intake of vitamin B12 through oral intake via appropriate foods or supplements. If an additional need for vitamin B12 arises, this should also be compensated for by vitamin B12-containing preparations. A change in diet and therapy of a diagnosed deficiency of folic acid is also significant to avoid pernicious anemia. If gastritis is suspected, a complete blood count is important to prevent the condition.
Follow-up
Ongoing follow-up is necessary even after treatment for pernicious anemia. Unfortunately, it is not possible to cure the disease, but it can be well controlled by permanent follow-up. Follow-up care consists mainly of regular intramuscular injections of vitamin B12 throughout the patient’s life. This is because the vitamin B12 present in the diet can no longer be absorbed by the small intestine as part of the disease. Therefore, without lifelong follow-up care, pernicious anemia would always be fatal. In the initial treatment of the disease, high doses of vitamin B12 are injected intramuscularly within the first three weeks. Thereafter, increased hematopoiesis begins, which in turn causes secondary iron deficiency. Thus, after treatment of the acute disease, follow-up care initially consists of monitoring the blood count, injections of vitamin B12, and additional administration of iron supplements. After this intensive treatment, fresh vitamin B12 must usually be injected every two months for the rest of the patient’s life to prevent renewed anemia. However, possible irreversible consequences of pernicious anemia, such as cardiovascular disease or psychological disorders, are also constantly monitored and treated as part of the follow-up care. Because pernicious anemia is usually due to autoimmunologic inflammation of the gastric mucosa with an increased risk of gastric cancer, the stomach should also be examined regularly.
What you can do yourself
Since pernicious anemia is caused in many cases by one’s own misbehavior, patients can also do a lot to get well quickly. Vegans and vegetarians who consume only small amounts of animal foods must get used to substituting vitamin B12 regularly and consistently. The easiest and most efficient way to do this is with dietary supplements. These preparations are available as tablets, effervescent tablets or or in drop form. Since vitamin B12 is stored in the liver, it is also possible to have the substance injected at regular intervals. This option is particularly suitable for people who have difficulty absorbing the vitamin when taken orally. In addition to dietary supplements, appropriately fortified foods can also be consumed. Here, however, it is important to calculate how much vitamin B12 is actually supplied. If the amount is not sufficient, additional toothpaste enriched with vitamin B12 can be used. This is available in organic supermarkets and health food stores and is also ideal for ensuring the supply while traveling. A good natural source of vitamin B12 is eggs. Ovo- and ovo-lacto vegetarians can increase their egg consumption.If otherwise hardly any animal foods are consumed, the additional cholesterol intake should be harmless. At the same time, care should be taken to ensure an adequate supply of iron, as acute iron deficiency exacerbates the course of pernicious anemia.
