Pernicious anemia

In addition to diseases of the lymphatic system, diseases of the blood system play a major role in medicine. A pernicious anemia occurs in both very young and adult people.

What is pernicious anemia?

The lack of vitamin B12 and the resulting anemia causes a variety of symptoms. Depending on the individual, these can occur in different order and intensity.
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The term anemia hides a blood disease which is also known colloquially as anemia. This is certainly due to the fact that a pernicious anemia is even externally visible if this condition is not treated.

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Pernicious anemia is just a disease of the blood-carrying system that only affects the red blood cells. The disease is based on a reduced maturation and storage of the 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 which one pernicious anemia and can trigger a very problematic course under certain circumstances, lie within processes that are associated with the production of hemoglobin.

The red blood pigment can only be formed if the appropriate conditions are met. 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 there is an insufficient supply of vitamin B12 due to insufficient oral intake, this can impair the so-called hemoglobin synthesis.

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Inadequate supply of vitamin B12 can be caused by alcoholism, the consumption of gastric protection preparations, various gastric diseases and stomach cancer. Nitrous oxide also binds vitamin B12 and an increased consumption of vitamin B12 during pregnancy can also cause pernicious anemia.

Symptoms, ailments & signs

The lack of vitamin B12 and the resulting anemia causes a variety of symptoms. Depending on the individual, these can occur in different order and intensity. In general, patients are burdened by continuous everyday fatigue with an associated loss of concentration. Even light, physical activities are quickly exhausting.

To compensate, normal rest periods extend beyond the usual extent. At the same time, the circulatory system is sensitive to stress. A generalized restlessness with increased heart rate and visible pallor can be seen. Dizziness is also less common.

Reddish, smooth tongues are another characteristic of pernicious anemia. Discomfort in the digestive tract leads to abdominal pain and irregularities in digestion. In addition, the VB12 deficiency favors a number of psychological and neurological effects that appear combined in the long term.

Affected people develop depression, often brood and experience anxiety. People often describe abnormal sensations in the body as pins and needles and a furry feeling in different parts of the body. As a typical symptom, humans develop permanent irritation of the autonomic nervous system. Superficial muscle twitching without affecting the movement of the limbs is occasionally noticeable.

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In theory, any part of the body can also be affected by numbness. Slowly increasing gait uncertainty due to coordination and balance problems complicates everyday life for the sick. With pronounced anemia, symptoms of paralysis occur in rare cases. However, these are not irreversible and can be cured with appropriate therapy. People perceive the disease as a great, emotional burden until the cause is clarified, since symptoms, seen individually, show similarities with serious clinical pictures.

Diagnosis & course

The pernicious anemia shows in the external appearance of those affected by a noticeable paleness of the skin and the mucous membranes. In addition, the performance of the patient 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 disorders with tingling and numbness in the extremities and disorders of balance. In addition, the clinical picture of pernicious anemia worsens due to impaired vision and depression, dementia deficits and a yellowish-gray color of the skin.

Further signs are an abnormal smoothness of the tongue surface and an increasing tendency towards circulatory collapse. These symptoms are important for diagnosis. In pernicious anemia, this is supplemented by a blood test. Various tests also enable a clear differential diagnosis. In connection with the disease, they include checking the gastric content in the blood plasma, the so-called Schilling test, and the determination of special antibodies.

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Complications

Pernicious anemia can lead to various complications. Most of the patients experience fatigue and weakness in particular, which is due to the lack of oxygen within the body. Without proper treatment, there is a risk of serious problems in various organs.

The heart is often affected by the sequelae of pernicious anemia. It has to work harder to provide oxygen for organs and tissues. Due to the unusually high output, symptoms such as heart murmurs, rapid heartbeat, cardiac arrhythmias or an enlarged heart can occur.

In the worst case, the person affected suffers from heart failure (heart failure). The cobalamin deficiency can also lead to heart disease. This increases the concentration of the chemical substance homocysteine ​​in the body. In the further course, a heart attack or a stroke are possible.

The nerve cells are also often affected due to the pernicious anemia. This is noticeable in neurological complaints such as tingling in the limbs, numbness, difficulty walking and loss of balance. The low cobalamin level also affects the sense of taste, smell and eyesight. Sometimes changes in the mind such as loss of memory or confusion also show up.

When should you go to the doctor?

Headaches, dizziness or abnormal sensations on the skin indicate a vitamin B12 deficiency. A doctor should be consulted if pernicious anemia develops. The disease manifests itself through incoordination, paralysis and other typical signs of anemia. If there are accompanying symptoms such as visual disturbances or depression, a doctor is recommended. The doctor can make the diagnosis on the basis of a blood count or a gastroscopy and, if necessary, inject vitamin B12 directly into the sick person.

After the injection is given, the pernicious anemia should resolve without further complications. The usual follow-up examinations ensure that no side effects occur. The patient should consult a nutritionist to avoid a new deficiency. If the symptoms are due to an illness, further examinations and treatments must be carried out. Pernicious anemia can occur, for example, as a result of type A gastritis or a parasitic disease.

Alcoholism and cancer are also possible triggers that must be clarified through further examinations. Internists, gastroenterologists, cardiologists and other specialists are responsible, depending on the cause and type of symptoms. In the event of psychological triggers, a psychologist or a psycho-oncologist can also be called in if the pernicious anemia occurs in connection with a cancer.

Treatment & Therapy

When treating the pernicious anemia is mainly based on compensating for the lack of vitamin B12 through medication. Basically, the blood-forming organs of humans require a constant supply of this vitamin. This is the only way to make hemoglobin synthesis possible.

If chronic inflammation of the gastric mucosa has resulted in pernicious anemia, vitamin B12 must be administered through the muscles, as the mucous membrane is unable to absorb this substance. If laboratory tests show that the supply of iron is inadequate, this deficiency must also be topped up in order to treat the disease.

Gastroenteritis should be treated appropriately for better absorption of vitamin B12. This therapy is unavoidable when the gastric mucosa is not able to transfer the vitamin B12 absorbed through food into the metabolism.

Outlook & forecast

The prognosis for pernicious anemia depends on the onset of therapy. Anemia treated early has the best chance of recovery. The disease can be remedied by increasing the supply of vitamin B12, the symptoms subside. If treatment is too late, irreversible damage can remain. The prognosis is unfavorable and there is no longer any prospect of a complete cure at this point in time. Diagnoses not made in time and / or improper treatment can cause depression, fatigue and neurological failures. In the worst case, the pernicious anemia becomes life-threatening. For a favorable prognosis, the patient must take the disease seriously and follow the advice of his family doctor.

Pernicious anemia requires the consistent use of vitamin supplements for a lifetime. Those affected can positively influence the prognosis by strictly adhering to the prescribed vitamin dose. In order to counteract or prevent pernicious anemia, a specialist can regularly check the vitamin balance. This takes place in the form of blood draws. Changes in the blood count are recognized in good time and can be treated successfully at an early stage. In addition to vitamin tablets, changed lifestyle habits and a healthier diet contribute to a favorable prognosis.

prevention

The prophylaxis against a pernicious anemia initially includes a sufficient intake of vitamin B12 through oral intake through appropriate foods or dietary supplements.

If there is an increased need for vitamin B12, this should also be compensated for by supplements containing vitamin B12. A change in diet and treatment of a diagnosed deficiency in folic acid is also important in order to avoid pernicious anemia. If there is a suspicion of gastric mucosal inflammation, a complete blood count is important in order to prevent the disease.

Aftercare

Continuous follow-up examinations are necessary even after treatment of pernicious anemia. Unfortunately, it is not possible to cure the disease, but it can be managed well with long-term follow-up measures. Follow-up care consists mainly of the fact that the patient receives regular intramuscular injections of vitamin B12 throughout their life.

Because the vitamin B12 present in food can no longer be absorbed by the small intestine as part of the disease. Without lifelong follow-up care, pernicious anemia would always be fatal. During the initial treatment of the disease, high doses of vitamin B12 are injected intramuscularly within the first three weeks.

Then the increased blood formation begins, which in turn causes a secondary iron deficiency. After the treatment of the acute illness, aftercare initially consists of monitoring the blood count, injections of vitamin B12 and an additional administration of iron supplements. After this intensive treatment, fresh vitamin B12 must usually be injected every two months for life to prevent recurrence of anemia.

In the context of aftercare, however, possible irreversible consequences of pernicious anemia such as cardiovascular diseases or mental disorders are constantly monitored and treated. Since pernicious anemia is mostly based on autoimmune inflammation of the gastric mucosa with an increased risk of gastric cancer, the stomach should also be examined regularly.

You can do that yourself

Since pernicious anemia is often caused by one's own misconduct, patients can also do a lot to help them get well again quickly.

Vegans and vegetarians who only consume small amounts of animal foods have to get used to regularly and consistently substituting vitamin B12. The easiest and most efficient way to do this is with dietary supplements. These preparations are available as tablets, effervescent tablets or in the form of drops. 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 ingested orally.

In addition to food supplements, appropriately fortified foods can also be consumed. But here it is important to calculate how much vitamin B12 is actually being supplied. If the amount is insufficient, toothpaste enriched with vitamin B12 can also be used. This is available in organic supermarkets and health food stores and is also ideal for ensuring supplies when traveling.

Eggs are a good natural source of vitamin B12. Ovo and ovo-lacto vegetarians can increase their egg consumption. If otherwise hardly any animal foods are consumed, the additional cholesterol ingested should be harmless. At the same time, care should be taken to ensure an adequate supply of iron, since an acute iron deficiency exacerbates the course of pernicious anemia.