How To Recognize and Treat Pernicious Anemia

Pernicious anemia is an autoimmune disorder and is more common in patients who already suffer from other types of autoimmune diseases. The steps in this article help us to recognize and learn about treatments for this potentially serious type of anemia. 

1. Symptoms of pernicious anemia are those of other types of anemia, with the addition of possible neurological symptoms in more severe cases. All anemic conditions result in low or inadequate red blood cell counts, causing the patient to have tired blood. This simply means that the red blood cells are inadequate to carry sufficient amounts of oxygen to the cells of the body for energy and the same is true of pernicious anemia.

   The general symptoms of anemia are weakness, headache, dizziness, pale complexion, fast heartbeat (tachycardia), shortness of breath, difficulty concentrating and cold extremities.

   People with pernicious anemia are also at risk of developing neurological symptoms if the condition worsens due to non-treatment. These symptoms include numbness; burning and tingling in the legs, arms, feet and hands; loss of muscle coordination and muscle weakness; ringing in the ears; dizziness and loss of balance; slowed or erratic reflexes; and irritability, confusion, anxiety and depression.

2. Pernicious anemia is caused by vitamin B-12 deficiency. Vitamin B-12 is an important vitamin that plays an essential role in the development of the red blood cells. In some countries were their diet is inadequate through low intake of foods rich in vitamin B-12, such as liver, meats and dairy products, they are at higher risk for developing pernicious anemia.
3. The low state of vitamin B-12 is often caused by an autoimmune process. In the U.S., poor diet is a less common cause. The highest percent of cases in the U.S. are caused by an autoimmune process, whereby the immune system turns on a natural substance in our digestive system and destroys it, rendering it incapable of absorbing proper amounts of vitamin B-12 from the foods we eat. This essential vitamin is absorbed by our bodies from the foods we eat, through the digestive system via a substance our bodies produce called “intrinsic factor”, a protein that allows for this absorption process to take place. In some people, especially those who have autoimmune diseases, the body will begin to create “antibodies” (killer cells from the immune system), directed against intrinsic factor. Over time, these antibodies begin to destroy this substance and the body will eventually have inadequate amounts for absorbing vitamin B-12 from our diet.

   People who already have disorders – such as autoimmune thyroid disease, Addison's disease (adrenal glands), lupus, rheumatoid arthritis and other autoimmune disorders – are at higher risk for developing pernicious anemia.
4. Pernicious anemia is treated by replacing the low vitamin B-12 level. When a doctor confirms that a person has becomes anemic, blood tests for the cause of the anemia will then be conducted. If the cause is found to be low B-12 levels, the treatment prescribed will be to replace the low vitamin and get it back to a normal level.
   • Most patients are given vitamin B-12 injections to replenish their low levels and they may need an injection administered on a regular schedule, such as once-monthly, for the rest of their lives.
   • Other patients may take B-12 orally in the form of tablets or liquid, as long as they do not have sensitivity to the oral form of vitamin B-12. It was once believed that injections were the only method of replacement, but recent medical research articles published on the “PubMed” medical research website state that oral B-12 in sufficiently high amounts can also successfully treat B-12 deficiency.
   • Some doctors might also administer an iron supplement to their patients in addition to replacement of their low B-12 level.
5. Blood testing of the B-12 levels is the most definitive test for pernicious anemia. Patients can confirm anemia through a “Complete Blood Count” blood test (CBC), but the test that definitively diagnoses pernicious anemia is a blood test of the vitamin B-12 level. Blood testing labs have normal ranges/values that vary, but if a lab has for example a normal range for vitamin B-12 of between “200 to 1200 pg/ml” and the patient’s result comes back as 150 pg/ml, this would indicate B-12 deficiency as the cause of the anemia.

   There is also a blood test to detect antibodies against the protein called intrinsic factor, and if this test comes back positive for these antibodies, this will reveal to the patient and to their doctor that the pernicious anemia is caused by an autoimmune process.