With pernicious anemia, the process of the red germ of hematopoiesis is disrupted. Irreversible phenomena occur in the body associated with a lack of vitamin B12. There are deviations from the side various systems organism.
Including the systems undergoing a pathological process include digestive pathology. That is, damage to the digestive system. The functioning of the stomach and liver is disturbed. From the side nervous system pathological phenomena are also observed.
Some sources describe this disease as a malignant pathology. In this case, the name of this anemia matters. Modern hematology has developed certain medical measures aimed at healing this disease.
What it is?
Pernicious anemia is a serious pathology associated with the development of anemia. As mentioned above, in some cases it is considered the most formidable disease. It is known that the lack of B 12 is replenished as a result of the use of products containing these vitamins.
Of great importance in the process of assimilation of the vitamin is the lifestyle of a person. People who lead a lifestyle associated with starvation are most susceptible to pernicious. Therefore, appropriate treatment is required.
Much depends on the accompanying pathology. In some cases, the disease occurs as a result of pathological processes. It is known that disorders in the digestive system can often lead to other diseases. After all, the direct absorption of vitamins into the human body occurs due to the proper functioning internal organs.
Causes
What are the main causes of pernicious anemia? The main etiology of the disease is associated with the influence of internal factors. There is also an alimentary way of intake of vitamins B 12 in the human body. Therefore, the causes of the disease are associated with the presence of adverse factors.
What exactly are the diseases that lead to pernicious anemia? Most often, the etiology of pernicious anemia is associated with the following pathological factors:
- atrophic gastritis;
- impact of medical interventions (gastrectomy);
- internal factor of Castle.
Of great importance in the etiology of the disease is enteritis, chronic pancreatitis, Crohn's disease. Tumor formations in the intestine also play a role. Often the causes of pernicious anemia are.
Pernicious anemia is caused by alcohol intoxication. Or the effects of drugs. What drugs cause pernicious anemia?
- colchicine;
- neomycin;
- contraceptives.
Symptoms
Pernicious anemia is predominantly manifested by the presence of symptoms characteristic of anemia. It is known that anemia is characterized by weakness, decreased performance and dizziness. The following symptoms are also distinguished:
- cardiopalmus;
- shortness of breath (with physical activity);
- heart murmurs.
Also noted external symptoms diseases. What is pallor skin, puffiness of the face. Complications of these conditions are not uncommon. Myocarditis occurs.
In some cases, heart failure may develop. From the organs digestive system there is a decrease in appetite. In most cases, dyspepsia can be observed. It is expressed in the phenomena of loose stools.
Pernicious anemia is characterized by enlargement of the liver. This is the most powerful argument for the development of anemia associated with a lack of vitamin B 12. The tongue in this disease has a crimson color.
Often the oral mucosa suffers. At the same time, stomatitis, glossitis and other pathologies are noted. The patient feels a burning sensation in the tongue. That is why the appetite is sharply reduced.
Gastritis with low acidity may be detected. As you know, gastritis hyperacidity most conducive to stomach ulcers. It is the most serious pathological condition.
From the side of the nervous system, neuronal damage is possible. That network nerve cells organism. In this case, the following symptoms are noted:
- numbness and stiffness of the limbs;
- muscle weakness;
- gait disturbance.
The patient may experience incontinence. And incontinence of urine and feces. Sensitivity is broken. The patient, especially in old age, notes:
- insomnia;
- depression
- hallucinations.
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Diagnostics
Of great importance in the diagnosis of pernicious anemia is the collection of anamnesis. Anamnesis involves the collection of the necessary information. This information relates to the possible causes of the disease. The clinical picture is established.
Diagnosis consists in an objective examination of the patient. At the same time, there are complaints from the patient. There are also signs of anemia. A biochemical study is also used.
It involves the detection of antibodies to the cells of the stomach. This includes the Castle factor. The predominantly used method general analysis blood. It shows the following trend:
- leukopenia;
- anemia;
- thrombocytopenia.
Of great importance in the diagnosis of the disease is the analysis of feces. In this case, the coprogram plays the role. Directly for the study of pathologies of the gastrointestinal tract. In the presence of helminths, feces on the worm egg are widely used.
If the cause is the pathology of the digestive system, then the Schilling test can be used in the diagnosis of the disease. This test allows you to determine a violation of absorption, directly vitamin B 12. If in pathological process tumor formations are involved, then additional studies are carried out.
Additional methods for diagnosing pernicious anemia include a bone marrow biopsy. This allows you to determine the increase in the number of megaloblasts. The FGDS method is widely used. In some cases, x-rays of the stomach are performed.
Diagnosis is also aimed at identifying cardiac pathologies. Therefore, electrocardiography is used ultrasound procedure bodies abdominal cavity. An MRI of the brain may be required.
Prevention
Preventive measures are aimed at filling the deficiency of vitamin B 12. Therefore, preference is given to the use proper nutrition. Nutrition should not only be balanced, but also contain vitamins necessary for the body.
What products should be preferred? Foods containing vitamin B 12 include:
- meat;
- eggs;
- liver;
- a fish;
- dairy products.
An obligatory condition in the prevention of the disease is the treatment of the underlying disease. Mostly diseases of the gastrointestinal tract. It is also necessary to avoid exposure to adverse factors. For example, alcohol intoxication should be excluded.
It is bad habits that can provoke pernicious anemia. Including the use of drugs. Drug intoxication should be limited.
If they were held surgical procedures, then it is advisable to carry out restorative treatment. IN this case treatment will be aimed at restoring the human body. Vitamins contribute not only to strengthening the immune system, but also to the absorption of necessary substances.
Expert advice is of great importance. These specialists include a gastroenterologist and an endocrinologist. Often, patients are registered with these specialists.
In the treatment of pernicious anemia great importance assigned to the elimination of vitamin B 12 deficiency. And therefore - its direct replenishment for the patient's body. However, this therapy can be carried out for life.
It is also necessary to check the stomach. This event is associated with the use of gastroscopy. This allows you to identify a tumor of the stomach. What is a common complication of this disease. Or the most significant reason for its development.
The introduction of vitamin B 12 is advisable to produce intramuscularly. The condition of the patient is also directly corrected. In this case, the following actions are relevant:
- elimination of helminths;
- intake of enzymes;
- surgical intervention.
Surgical intervention is advisable to carry out with the aim of direct removal malignant neoplasms. Including tumors of the stomach and intestines. Nutritional modification includes a diet containing animal protein.
If the patient's condition is preceded by an anemic coma. What is also a frequent complication, you should resort to blood transfusion. That is, apply the methods of blood transfusion.
In adults
Pernicious anemia in adults can be observed in some cases. This is primarily related to various pathologies. This is especially true in old age. Anemia after seventy years is the most dangerous.
Pernicious anemia develops in the category of forty years and above. Naturally, the older the patient, the more serious the course of the disease. In addition, anemia does not develop immediately. Usually after a certain period of time.
This period of time can be quite long. Make a time period of four years. The course of the disease in the elderly is quite severe. First of all, this is due to the following factors:
- the presence of neurological disorders for a long time;
- lifelong use of drugs;
- occurrence of complications.
Adults have to live with drugs. Moreover, these drugs should directly restore the deficiency of vitamin B 12. If the cause of the vitamin deficiency is a tumor, then an adult is most susceptible to complications.
Symptoms of pernicious anemia in adults are as follows:
- decrease in working capacity;
- lethargy;
- dizziness;
- insomnia.
A significant symptom of the disease in adults is insomnia. At the same time, a person is excited, frequent lack of sleep affects his ability to work. After all, the phenomena of pernicious anemia are not uncommon in people of the middle age category.
Oddly enough, women are susceptible to the disease. Men get pernicious anemia less often. Therefore, it is necessary to clearly define possible reasons this pathology. Causes of illness in adults include:
- pathology of internal organs;
- malignant neoplasms;
- medicinal substances;
- body intoxication.
In children
Pernicious anemia in children is manifested by the presence of severe symptoms. Children with anemia lag behind in development. They are the most susceptible various diseases. Often anemia in children is caused by the following factors:
- severe pregnancy;
- maternal infections;
- prematurity
Take place genetic diseases. Usually diseases associated with circulatory system contribute to the development of anemia. For example, hemophilia. That is a direct violation of blood clotting.
What are the main symptoms of the disease in a child? To the main clinical signs include:
- fragility of nails;
- pale skin;
- weakness;
- dizziness.
In severe cases, children develop stomatitis. Children with pernicious anemia are at risk for respiratory pathology. More often they get bronchitis and pneumonia. In children early age there is tearfulness, exhaustion.
In children, tachycardia is often detected. May decline arterial pressure. Up to the development of collapse. The child may faint. For infants, pernicious anemia has the following symptoms:
- regurgitation is frequent;
- vomiting after feeding;
- flatulence;
- decreased appetite.
Forecast
With pernicious anemia, the prognosis largely depends on the presence of complications. The prognosis is best if carried out timely treatment. If the treatment is late, then the prognosis is the worst.
Much depends on the presence of the underlying disease. With malignant pathology, the prognosis is unfavorable. In the presence of cardiac abnormalities, the prognosis is also the worst.
The disease is quite long. The prognosis will directly depend on the condition of the patient. Also from the course of the underlying disease. And of course, from the availability of adequate therapy.
Exodus
Fatal outcome with pernicious anemia is possible if there is malignant tumor. Even in the presence of a long medical therapy The outcome will depend on what happens next. The outcome is favorable if the patient follows some recommendations.
First of all, the outcome will depend on the correction of lifestyle and nutrition. Especially in the presence of an intoxication factor and alimentary etiology. In people over the age of seventy, the outcome is often unfavorable.
Recovery is possible. But treatment therapy is quite long. May vary from several years. Moreover, the outcome in this case may be associated with life-long intake of this vitamin.
Lifespan
In the treatment of pernicious anemia, consultation and supervision of specialists is of great importance. In some cases, the further course of the disease depends on this. And also longevity.
If the disease was eliminated in a timely manner, then life expectancy increases. If the diagnosis is late, which can be often, then the disease ends with a decrease in the quality of life. The patient may be suffering from heart failure.
With heart failure, the course of the disease is aggravated. And the presence of an anemic coma worsens the quality of life, reduces its duration. Urgent action must be taken.
Anemia is a disease characterized by a decrease in the concentration of hemoglobin in the blood. Today we will talk about pernicious anemia, we will also briefly consider other types of anemia (classification and severity).
Pernicious anemia is a serious pathology that develops as a result of a deficiency in the body of vitamin B12. This disease has several names: pernicious anemia, Addison-Birmer disease, megaloblastic anemia, B12 deficiency anemia.
A bit of history
In 1855, the English doctor Thomas Addison first described this disease. In 1872 german doctor Anton Birmer studied the disease in more detail. It was he who named the disease pernicious, or pernicious anemia. However, it was not known at the time what treatment was needed for anemia. of this type. And only in 1926, a group of doctors found that the signs of the disease completely disappear after the introduction of raw liver into the patient's diet. The same experts proved that the basis of such a disease is a condition in which the stomach, due to congenital pathology is not able to secrete a special substance (Castle factor), which helps to absorb vitamin B12 in the intestines. Scientists were awarded the Nobel Prize for this discovery.
Types of anemia: classifications
What are the types of anemia? This disease develops various reasons, the history of illness can be various also. Anemia is divided into the following types:
Posthemorrhagic - the disease develops against the background of acute or chronic blood loss (injury, bleeding).
Hemolytic - the occurrence of pathology is associated with enhanced destruction erythrocytes.
Deficiency - the disease develops due to a lack of substances necessary for hematopoiesis (iron, vitamins and other trace elements).
Hypoplastic - the most severe type of anemia, this condition occurs as a result of impaired hematopoiesis in the bone marrow.
Anemia: the severity of the disease
In addition to the above classification, clinicians distinguish between the disease and the severity. This indicator depends on the concentration of hemoglobin. Anemia disease severity has the following:
medium - the amount of hemoglobin for men is 80-100 g / l, for women - 70-90 g / l;
severe - the level of hemoglobin falls below the above limits.
Causes of pernicious anemia
Before answering the question: “How to treat pernicious anemia?”, It is necessary to find out what contributed to its occurrence. This disease can develop for various reasons. As mentioned above, the main one is the lack of vitamin B12 in the body. Pernicious anemia can also develop as a result of:
Signs of the disease
How does pernicious anemia manifest itself? Symptoms can be both overt and indirect. TO clear signs Addison-Birmer disease includes:
bright red (scarlet) tongue, which, due to deformation of the receptors, becomes “varnished”;
dysfunction of the nervous system;
gastric akhiliya - a condition in which hydrochloric acid and enzymes are absent in the gastric juice;
the presence of pathological erythrocytes, anemia;
formation in the bone marrow is unnatural large cells(megaloblasts) instead of red blood cells.
Indirect symptoms of the disease are:
weakness, drowsiness, decreased vitality;
pain in the mouth and on the tongue;
pain in the limbs;
weight loss, loss of appetite.
These signs of pathology develop most often. Rarely, pernicious anemia can present with:
change in gait;
violation of urination;
visual impairment;
sexual disorders;
hallucinations;
mental disorders.
Development of pernicious anemia during pregnancy
The disease can develop in pregnant women. Pernicious anemia occurs as a result of insufficient intake of the expectant mother folic acid and cyanocobalamin. In this case, the level of red blood cells decreases in the blood, but hemoglobin remains normal or increases. The disease develops rather slowly, and in order to diagnose "pernicious anemia" on early stage, it is necessary to carry out clinical trial blood. Therefore, the timely conduct of all tests prescribed by the doctor is extremely important. The disease is manifested by pallor of the skin, weakness, increased fatigue, later digestive disorders join. It is extremely rare that the nervous system is affected, and there may be a slight decrease in sensitivity in the extremities.
During pregnancy, pernicious anemia must be cured, since in most cases the pathology can provoke placental abruption, the risk of preterm birth and dead birth child.
Treatment of the disease is carried out according to the general scheme.
Anemia pernicious in children
More often this disease develops in children with hereditary pathologies digestive system, as a result of which the absorption of vitamin B12 is impaired. Rarely, a child may develop pernicious anemia when breastfeeding mother is a vegetarian. A blood test makes it possible to make a correct diagnosis already in the third month of life, the symptoms of pathology begin to appear only when the child reaches 3 years of age. On examination, the doctor may detect dryness and peeling of the skin, glossitis, enlarged spleen. There is indigestion, appetite decreases. In especially severe cases, the child may lag behind in development.
Diagnosis of the disease
The most obvious manifestation of pathology is observed in the composition of the blood. As a rule, all patients have a low concentration of vitamin B12 in the serum. For absorption of the vitamin, additional administration of intrinsic factor is required. A urine test is also carried out, since a comparative analysis of the composition of urine and blood makes it possible to make a more accurate diagnosis.
It is very important to find the root cause of the disease. Specialists conduct a study of the gastrointestinal tract for the possible detection of gastritis, ulcers and other pathologies, as a result of which the absorption of vitamin B12 could be impaired.
Treatment of pathology
If pernicious anemia is diagnosed, treatment is carried out by administering medications such as Oxycobalamin or Cyanocobalamin. The drugs are administered by injection. First of all, it is necessary to bring the concentration of vitamin B12 to normal values, later the number of injections is reduced, and the administered medicine has only a supporting effect. After the therapy, patients will have to constantly monitor the level of the vitamin and periodically undergo a prophylactic course of injections of the drug.
In some cases, during treatment, patients may experience a decrease in the concentration of iron in the body. This usually happens after 3-6 months of treatment. In such a situation, additional administration of medications that restore iron levels is required.
With successful therapy, all manifestations of the disease gradually disappear. Duration recovery period may be 6 months. The content of vitamin B12 normalizes 35-70 days after the start of treatment.
In the process of treatment, neuropathy is eliminated, urinary incontinence and other signs disappear in all patients. Vision that was impaired as a result of optic nerve atrophy, unfortunately, is not restored. But if visual impairment arose due to hemorrhages yellow spot, the recovery is quite fast.
It should be borne in mind that in some cases, after treatment, such serious illness like toxic goiter, myxedema, stomach cancer. However, this happens quite rarely (no more than 5% of cases).
Nutrition principles
We found out how to treat pernicious anemia, but we should not forget about a balanced diet. Daily diet should contain a sufficient amount of vitamins and proteins. Be sure to regularly eat beef, rabbit meat, seafood, eggs, dairy products, legumes. It is recommended to limit the amount of fats in the diet, as they slow down the processes of hematopoiesis in the bone marrow. You should also stop smoking and drinking alcohol. For successful treatment positive emotions and support from family and friends are extremely important. Be attentive to your body, take regular tests and immediately respond to the slightest changes in your health.
When vitamin B12 is deficient in the bone marrow, normal red blood cell precursors are replaced by megaloblasts, abnormally large cells that are unable to transform into red blood cells. If left untreated, the patient develops anemia and nerve degeneration.
General information
Pernicious anemia was first described by Addison in 1855, describing the disease as "idiopathic anemia" (anemia of unknown origin).
A detailed clinical and anatomical description of the disease belongs to Birmer (1868). It was Brimer who gave the name “pernicious anemia” to the disease, i.e. pernicious anemia.
For a long time, the disease was considered incurable, but in 1926, Minot and Murphy made the discovery that pernicious anemia can be cured with raw liver (liver therapy). This discovery and subsequent work by the American and physiologist W. B. Castle formed the basis of modern ideas about the pathogenesis of this disease.
W. B. Castle found that normally a person produces not only hydrochloric acid and pepsin, but also a third (internal) factor - a complex compound consisting of peptides and mucoids, which is secreted by mucocytes (cells of the gastric mucosa). This compound forms a labile complex with an external factor (vitamin B12), which, after entering the blood plasma, forms a protein-B12-vitamin complex accumulating in the liver. This complex is involved in hematopoiesis. W. B. Castle revealed the absence of secretion in the stomach of the internal factor in patients with pernicious anemia, but did not establish the chemical nature of the external factor.
The substance (vitamin B12) playing the role of an external factor was established in 1948 by Ricks and Smith.
The disease is quite common - the prevalence rate is 110-180 patients per 100,000 population. Residents of the UK and the Scandinavian Peninsula are most susceptible to the disease.
In most cases, pernicious anemia affects people who belong to the older age group(observed in 1% of people over 60). If there is a family predisposition to the disease, the disease is detected at a younger age.
In women, the disease is observed more often (10:7 in relation to males).
Forms
Pernicious anemia, depending on the amount of hemoglobin in the blood of patients, is divided into:
- a mild degree of the disease, which is diagnosed with hemoglobin from 90 to 110 g / l;
- anemia medium degree severity, detected with hemoglobin from 90 to 70 g / l;
- severe anemia, in which the blood contains less than 70 g / l of hemoglobin.
Depending on the cause of the development of B12-deficiency anemia, there are:
- Nutritional or nutritional anemia (develops in young children). It is observed with a lack of vitamin B12 in the diet (vegetarians, premature babies and children fed with milk powder or goat's milk).
- Classical B12-deficiency anemia associated with atrophy of the gastric mucosa and the absence of an "internal" factor.
- Juvenile B12 deficiency anemia, which develops due to functional insufficiency of the fundic glands producing glandular mucoprotein. Gastric mucosa and secretion of hydrochloric acid are preserved. This disease is reversible.
Separately, familial B12-deficiency anemia (Olga Imerslund's disease) is distinguished, which is caused by impaired transport and absorption of vitamin B12 in the intestine. Patients with this disease have protein in the urine (proteinuria).
Reasons for development
Pernicious anemia develops in the body:
The causes of the disease also include an autoimmune factor - in 90% of patients, the presence of circulating autoantibodies to stomach cells that secrete hydrochloric acid and internal factor of Castle (there are also present in 5-10% healthy people), and in 60% of patients - antibodies to internal factor Castle.
Pathogenesis
Normally, with food, 6-9 micrograms of vitamin B12 per day enter the human body (2-5 micrograms are excreted, and about 4 micrograms are retained in the body). Since the reserves of vitamin B12 in the body are significant, malignant anemia develops only after a long period (about 4 years) after the cessation of its intake or violation of its absorption.
Deficiency of cyanocobalamin (vitamin B12) leads to deficiency of its coenzyme forms - methylcobalamin and 5-deoxyadenosylcobalamin. Methylcobalamin is necessary for the normal course of the formation of erythrocytes, and 5-deoxyadenosylcobalamin provides metabolic processes in the central nervous system and peripheral nervous system.
With a deficiency of methylcobalamin, the synthesis of nucleic acids and essential amino acids is disrupted and a megaloblastic type of hematopoiesis develops. Erythrocytes in the process of formation and maturation take the form of megaloblasts and megalocytes, which are rapidly destroyed and are not able to perform an oxygen transport function. As a result, the number of erythrocytes in the peripheral blood is significantly reduced and anemic syndrome develops.
An insufficient amount of 5-deoxyadenosylcobalamin causes a metabolic disorder of fatty acids, which provoke the accumulation of toxic methylmalonic and propionic acids in the body. These acids have a damaging effect on the neurons of the brain and spinal cord, contribute to the disruption of myelin synthesis and degeneration of the myelin layer, so pernicious anemia is accompanied by damage to the nervous system.
Symptoms
Pernicious anemia manifests itself:
- Anemic syndrome, which is accompanied by general weakness, decreased performance, subfebrile condition, dizziness, fainting spells. The syndrome is also manifested by shortness of breath, which occurs even with minor exertion, and flickering. The skin becomes pale with a slightly yellowish tint, and the face becomes puffy. With auscultation of the heart, systolic murmurs can be detected, and with a prolonged course of anemia, myocardial dystrophy and heart failure develop.
- Gastroenterological syndrome, which is accompanied by nausea and vomiting, loss of appetite and body weight, constipation. There is also a hunter's glossitis (the structure of the tongue changes due to a lack of vitamin B12), in which the tongue acquires a crimson or bright red hue, and its surface becomes smoothed, "varnished". The patient experiences a burning sensation in the tongue. Perhaps the development of angular (localized in the corners of the mouth) stomatitis. Gastric secretion is largely reduced, gastroscopy reveals atrophic changes in the gastric mucosa.
- neurological syndrome. With a deficiency of vitamin B12, muscle weakness is observed, the gait becomes unstable, the legs become stiff, the patient experiences numbness of the extremities. Prolonged deficiency of vitamin B12 leads to damage to the spinal cord and brain (vibration, pain and tactile sensitivity disappears, convulsions occur). Examination reveals an increase in tendon reflexes, the presence of Romberg's symptom (loss of balance during closed eyes) and the Babinski reflex (extension of the first toe during dashed skin irritation of the outer edge of the sole), signs of funicular myelosis.
Megaloblastic anemia may be accompanied by irritability, low mood, and impaired urination. Sometimes impotence and visual disturbances develop.
With brain damage, there may be a violation of the perception of yellow and blue flowers, in rare cases, hallucinations and other mental disorders are observed.
Diagnostics
Pernicious anemia is diagnosed by:
- Analysis of patient complaints and anamnesis of the disease, during which the doctor specifies the duration of the disease, the presence of hereditary and concomitant diseases, etc.
- Physical examination data. During the examination, the doctor pays attention to the shade of the skin, pulse and blood pressure (with B12-deficiency anemia, the pulse is often quickened, and blood pressure is reduced). Language must be checked.
- Data from laboratory tests.
Laboratory tests include:
- A blood test that allows you to detect a decrease in the number of red blood cells, an increase in their size, a decrease in the precursor cells of red blood cells (reticulocytes), reduced level hemoglobin, decreased platelet count and their increase in size. Also, a change in the color index (the ratio of the first three digits of the number of erythrocytes and a 3-fold increase in the level of hemoglobin) is detected upwards - at a rate of 0.86 to 1.05 with pernicious anemia, this ratio exceeds 1.05.
- Urinalysis, which allows you to identify concomitant diseases (pyelonephritis, etc.), as well as suggest a hereditary form of the disease.
- A biochemical blood test that allows you to detect a decrease in the blood level of vitamin B12, determine the level of cholesterol, uric acid, glucose, detect creatinine (protein breakdown product). Megaloblastic anemia is often accompanied by an increase in the level of bilirubin formed during the breakdown of red blood cells, the level of iron as a result of a decrease in its use in the formation of new red blood cells, and the level of accelerating chemical reactions enzyme lactate dehydrogenase.
For bone marrow examination general anesthesia a puncture is made in the region of the anterior and posterior iliac spines (to exclude data distortions, the study is carried out before the appointment of vitamin B12). Analysis of the myelogram reveals the megaloblastic type of hematopoiesis and increased formation of red blood cells.
In addition, they carry out:
- ECG, which can detect an increased heart rate and, in some cases, heart rhythm disturbances.
- Gastroscopy, which allows to detect the absence of hydrochloric acid in the gastric juice (achlorhydria) and atrophic gastritis, affecting the departments in which the secretion of hydrochloric acid and pepsin occurs. Since the cells of the gastric epithelium look like atypical during cytological examination, differential diagnosis with stomach cancer.
- Radiography of the stomach, ultrasound of the abdominal organs.
- MRI of the brain and examination by a neurologist.
Assessment of vitamin B12 absorption is carried out using the Schilling test. The patient takes radioactive vitamin B12 orally, and after a few hours he is parenterally injected with a "shock" dose of unlabeled vitamin. Then the content of the radioactive vitamin in daily urine is measured. With preserved kidney function, a decrease in its excretion indicates a decrease in absorption of vitamin B12 in the intestine.
Treatment
Treatment of megaloblastic anemia is aimed at eliminating the cause of the disease and normalizing hematopoiesis. Therapy includes:
- Treatment of diseases of the gastrointestinal tract (glucocorticosteroids are prescribed for autoimmune damage to the stomach), a balanced diet, which includes dairy products, beef, seafood, eggs and rabbit meat.
- The use of praziquantel or fenasal in diphyllobothriasis.
- Replenishment of vitamin B12 deficiency.
Pernicious anemia is treated with the introduction of cyanocobalamin (vitamin B12) for 4-6 weeks subcutaneously 1 time per day, 200-500 mgk. Then the vitamin is administered once a week (the course is 3 months), and then they switch to injections 2 times a month for six months (the dose does not change).
Normalization of hematopoiesis occurs approximately 2 months after the start of treatment (the exact timing depends on the severity of anemia).
Red blood cell transfusion is performed only in anemic coma or severe anemia.
Prevention
Prevention of the disease is reduced to:
- good nutrition;
- timely treatment of diseases that cause vitamin B12 deficiency;
- taking a maintenance dose of cyanocobalamin after removal of part of the stomach or intestines.
Health
Pernicious anemia is a condition in which an ill person's body is no longer able to produce the required amount of healthy red blood cells due to a vitamin B12 deficiency ( nutrient found in certain foods).
For example, people who suffer from pernicious anemia are unable to absorb enough vitamin B12 due to a lack of so-called intrinsic factor (a protein produced in the stomach).
However, other causes and conditions can also lead to vitamin B12 deficiency.
Causes of pernicious anemia and risk factors
-- One of the most common causes is a lack of "intrinsic factor" in the stomach, which causes the body to become unable to absorb enough vitamin B12.
-- Some cases of pernicious anemia are due to the presence of harmful bacteria in the small intestine, which in turn causes the small intestine to not absorb vitamin B12 properly; interfere with the absorption of vitamin B12 and some diseases, taking certain medications, surgery for partial or complete removal small intestine, as well as teniidosis (the presence of worms of a certain group).
-- Another reason why the human body may not receive adequate amounts of vitamin B12, resulting in pernicious anemia, is the lack of this vitamin in the patient's diet.
There are also several risk factors that increase the risk of pernicious anemia:
-- Having a family history of the condition (family history).
-- If there was an operation to partially or completely remove the stomach.
-- If there are some autoimmune diseases that affect the glands internal secretion(for example, chronic insufficiency of the adrenal cortex (Addison's disease), diabetes of the first group, Graves' disease and vitiligo).
-- If there was surgery to partially or completely remove the small intestine.
-- If there are certain gastrointestinal diseases or disorders that prevent the patient's body from properly absorbing vitamin B12.
-- If certain medical preparations, one of the side effects of which is also that the body temporarily ceases to properly absorb vitamin B12.
-- If the patient follows a strict vegetarian diet, not allowing himself a single gram of meat and dairy products and refusing to take vitamin B12 supplements. Very often, poor nutrition in general is a risk factor.
Symptoms and treatment of pernicious anemia
In addition to the symptoms that are characteristic of all types of anemia (fatigue, dizziness, and so on), vitamin B12 deficiency is accompanied by characteristic serious signs:
-- Nerve damage.
-- Neurological problems such as confusion, dementia, depression and memory loss.
-- Symptoms related to gastrointestinal tract and includes nausea and vomiting, heartburn, bloating and gas, constipation or diarrhea, loss of appetite and weight loss.
-- Enlargement of the liver.
-- Swelling of the tongue, which loses its roughness and becomes smooth.
-- Infants who suffer from vitamin B12 deficiency may show poor reflexes, inappropriate body movements, and facial twitching.
Interventions for the treatment of pernicious anemia usually include the replacement of vitamin B12 that is not being received by the body.
Treatment can be highly successful, but requires a long period of time and sometimes lasts throughout the life of the patient.
A disease like pernicious anemia has a strong similarity with the usual anemia caused by a lack of vitamin B12. Both diseases are characterized neurological manifestations and megaloblastic process of hematopoiesis.
Pernicious anemia (from Latin perniciosus - fatal, dangerous) or B12-deficiency anemia or megaloblastic anemia or Addison-Birmer disease or (obsolete name) malignant anemia - a disease caused by impaired hematopoiesis due to a lack of vitamin B12 in the body. The bone marrow and tissues of the nervous system are especially sensitive to the deficiency of this vitamin.
The specificity of this disease is the mandatory presence of three constituent causes:
- aggravated stage of atrophic gastritis;
- deficiency of vitamin B12, resulting from the difficulty of assimilation, regardless of the quantitative composition in food;
- the transformation of hematopoiesis into a megaloblastic type, which is typical for the embryonic development of the human body.
The second name of this pathology is pernicious or benign anemia, occurring in 1-2%, mainly after the age of sixty. Women are more commonly affected by this disease than men. In the case when there is a genetic predisposition, then people at a young and middle age can get sick.
Causes of pernicious anemia
The first description of the symptoms and causes of pernicious anemia was presented in the second half of the nineteenth century by the English physician Addison, and the second version was described by Birmer thirteen years later. The opinion of both doctors was that the disease could not be cured because the underlying causes had not been identified.
In 1870, the relationship of anemia with atrophy of the gastric mucosa and with the interruption of the production of pesinogen was proved.
Further study of the disease made it possible to determine characteristics and the degree of modification in the stomach. It turned out that the necrosis of parietal cells occurs in most of the mucosa and, along with this, the possibility of producing the enzyme is lost. Dead cells are replaced by others, similar to intestinal mucus production.
The walls of the digestive organ are infiltrated by lymphocytes and plasma. Such changes occur not only with pernicious anemia, but also with atrophic gastritis, and even with a long course of the disease, anemia is not observed.
Studies have shown that the presence of two more factors is also necessary for the occurrence of pernicious anemia:
- genetic predisposition.
- Autoimmune state of the body.
The impact of immunity has been proven by the method of immunofluorescence of 2 types of antibodies in the blood serum of patients:
- in 90% of patients to parietal cells;
- in 57% of patients to the internal factor that produces the enzyme.
Basically, antibodies are also detected in gastric juice, which inhibit the absorption of vitamin B12.
Modern knowledge about immunity makes it possible to get a more complete picture of the causes of the disease. The genetic factor is confirmed by the presence of antibodies in healthy relatives. In case of malfunction immune system antibodies appear against cells in the pancreas and thyroid gland as well as the adrenal glands.
To determine which manifestation is primary, a disease of the digestive organ or autoimmune processes, has not yet been clarified. Both symptoms are aggravated at the expense of each other and make it difficult to restore the mucosa.
The appearance of a lack of vitamin B12 occurs gradually as parietal cells shrink. In some cases, signs of anemia appear after five or more years.
Violation of hematopoiesis The clinic of Addison-Birmer disease consists in the manifestation common symptoms anemia in combination with digestive and neurological disorders. These signs include:
- severe fatigue, lethargy;
- feeling of heaviness after eating in the epigastric region;
- pain in oral cavity and in language;
- feeling of numbness of the skin of the lower and upper extremities;
- slight weight loss, but mostly a tendency to be overweight;
- in the acute period, a disruption in the functioning of the intestine and a change in the color of the feces are likely;
- an increase in body temperature due to the accelerated breakdown of red blood cells.
There may also be other symptoms, but they are rare. These include:
- deterioration of potency in men and impaired urination;
- change in gait;
- vision dysfunction.
With damage to the visual, olfactory and auditory nerve fibers, there is a violation of vision, smell and hearing. Very rarely recorded mental disorders and hallucinations.
Diagnosis of B12-deficiency anemia
At a doctor's appointment in a patient, after a thorough diagnosis of B12 deficiency anemia, it can be found:
- pallor of the skin;
- swelling of the face;
- brown pigment spots in the nose and cheekbones;
- insignificance of hysteria of the sclera.
When examining the oral cavity, the following symptoms are revealed:
- in the initial stage of the disease, painful lesions appear in the form of cracks;
- occurrence inflammatory process with ulcers on the gums and mucous membranes, and then spreading into the pharynx and esophagus;
- in acute period disease, the tongue acquires a scarlet color due to atrophy and swelling of the folds.
When probing the abdomen, the soft part of the liver is determined with an increase in size. Changes in the spleen are extremely rare.
Which additional examination necessary?
The diversity of the disease requires confirmation of the diagnosis by various specialists:
- An examination by a neurologist helps to establish the lost sensitivity of the legs and arms, impaired motor functions which are indicative of damage to the myelin sheaths in spinal cord.
- To exclude the possibility of the formation of a low-quality formation, an endoscopy of the stomach should be performed. The presence of atrophic gastritis is characterized by the appearance of shiny zones where cell death occurs.
- Conducting fluoroscopy shows increased evacuation and alignment of mucosal folds.
- To prove the low absorption of vitamin B12 in the stomach, a Schilling diagnosis is made, in which the amount of the isolated element after administration is determined. A check is also made to see if the reduction in blood and urine levels is consistent. A low score indicates in large numbers antibodies in gastric juice.
5. When researching gastric juice low saturation with hydrochloric acid or its complete absence and a large amount of mucus are detected.
6. Histology of the mucosa shows thinning and disappearance of the glandular epithelium. Pernicious anemia is characterized by the absence of gastromucoprotein and acid secretion.
7. Cardiogram reveals oxygen starvation myocardium. The presence of tachycardia contributes to the development of arrhythmia, ischemia and early cardiosclerosis.
Blood picture with vitamin B12 deficiency
With a shortage of 12 Vitamin B12 deficiency can lead to impaired hematopoiesis in the bone marrow. There is a decrease in hemoglobin, while the fall in the number of red blood cells is even greater.
Peripheral blood analysis reveals the presence of large cells of megalocytes and macrocytes, which are twice the size of an erythrocyte. Probably the appearance of cells with a modified structure and the remains of nuclei.
There are also changes in the following indicators:
- the quantitative composition of reticulocytes decreases;
- the growth of white blood is inhibited, which contributes to the formation of leukopenia and relative lymphocytosis;
- the number of platelets decreases, but growth in size is activated;
- Blast cells of the erythrocyte series of different maturity predominate in the bone marrow.
During remission, bone marrow hematopoiesis returns to normal.
Treatment for pernicious anemia
The main direction in the treatment of this disease is to eliminate the lack of vitamin B12. For this, it is assigned medicinal product Oxycobalamin, which is considered the most effective in the first stage of treatment.
If after six months there is a lack of iron, then iron-containing preparations in tablets.
As a result of treatment, the number of reticulocytes increases, well-being improves, dizziness disappears, strength appears in the limbs. Stabilization will take at least a month and a half.
Features of the flow B 12 -deficiency anemia
Difficulties in diagnosis arise when there are clinical symptoms without changes in hematopoiesis. In this case, the diagnosis is atrophic gastritis, and not Addison-Birmer disease.
Fluctuations in the correctness of the diagnosis appear when backlash on the introduction of vitamin B12 and the absence of neurological signs. It is also worth considering that the effectiveness of treatment can be eliminated by the diseases already present in the patient:
- pyelonephritis in chronic form;
- kidney dysfunction;
- the presence of infection in the body for a long time;
- diseases thyroid gland;
- malignant formations.
Forecast
Rarely seen nowadays launched form pernicious anemia, this is possible only in the absence of medical therapy. At the moment, the disease is curable, but requires medical supervision and prevention of remission.
With a long course of the disease, patients manifest concomitant pathology:
- toxic diffuse thyroid disease is found in 1.8% of patients;
- endocrine disease myxedema is found in 2.4% of cases.
The primary symptoms of cancer are:
- nonspecific weight loss;
- resistance to the drug cyanocobalamin;
- restoration of hematopoiesis with existing symptoms.
Incomplete study of the causes and consequences of Addison-Birmer anemia is a reason for the patient to take an active position in preventive actions against relapses. To do this, you should eat well and eat right, refuse bad habits and take care of your health.
