Symptoms, Treatment Options for Pernicious Anemia

Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses pernicious anemia symptoms, diagnosis and treatment.

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Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses pernicious anemia symptoms, diagnosis and treatment.
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Featuring Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist

Duration: 3 minutes, 36 seconds

Pernicious anemia. Pernicious anemia is a vitamin B12 deficiency. Vitamin B12 deficiency is not uncommon, it’s about one percent of us as we grow older. And it can be more common in certain groups who are at risk for deficiency. Particularly those who have had autoimmune diseases like type 1 diabetes or they’ve had surgery to their intestines, particularly to the stomach, or the ileum, the end of the small bowel.

The symptoms of vitamin B12 deficiency can be simply fatigue and being tired in the early stages, which is difficult to diagnose. In more severe, more involved patients who are more profoundly deficient, it can cause a peripheral neuropathy with numbness of the feet and the lower legs.

It can affect the balance and strength to the lower limbs, because of affecting the spinal cord. It can affect the vision with optic atrophy or actual damage to the optic nerve, or in severe cases it can present with a dementing-like illness and look something like Alzheimer’s.

Fortunately in today’s world the disease does not get to those more serious manifestations, and it’s diagnosed generally earlier with fatigue or anemia. The diagnosis is made by measuring a vitamin B12 level, which is easy to do, and also suspecting it based on the symptoms.

There’s a characteristic abnormality of one’s blood if you’re B12 deficient. In addition to becoming anemic, which is a decrease in the red blood cells, the red blood cells get very big. Big blood cells are called macrocytosis, and it’s measured by the MCV parameter on the blood testing. And a very high MCV is highly suggestive of vitamin B12 deficiency, and that’s often the first clue.

Once the diagnosis has been made, vitamin B12 supplementation is necessary. Historically, we put people on vitamin B12 injections forever when the diagnosis was made, and it’s actually not necessary in many patients.

Because it is possible to absorb vitamin B12 in different fashions, or in different mechanisms, even if the main absorptive mechanism is defective, if you give enough vitamin B12 orally, you can often get away with not having to have regular injections.

A common practice, therefore, once your physician has diagnosed vitamin B12 deficiency, is to give you a short course of injections of B12 to put the blood level well back into the safe range. Then, have you take oral supplementations, and then follow you along over time to show that the oral supplementations keep you in the normal range without having to resort to regular injection therapy.

So if you think you have vitamin B12 deficiency or are concerned about it, discuss it with your primary care practitioner.

Presenter: Dr. Richard Bebb