Pernicious anemia is a condition where there is reduced red blood cell (RBC) production in the bone marrow due to lack of sufficient Vitamin B 12. Pernicious anemia occurs when the body is unable to absorb Vitamin B12. This is due to lack of an ‘intrinsic factor’ (IF), a protein which helps in absorbing Vitamin B12 from the alimentary system.

Who gets Pernicious anemia?

Most commonly in

- Women more than men.

- Elderly (average age ≥ 60 years).

- Scandinavians & North Europeans

- Occasionally one type of the disorder is seen in children.

How does Pernicious anemia occur?

Vitamin B12 is very essential for

- Production of red blood cells

- Growth and development of children

- Maintenance of the nervous system

The human body cannot prepare Vitamin B12. The Vitamin B12 obtained from foods is absorbed in the alimentary system. Without the intrinsic factor produced by the inner lining of the stomach, it is impossible for the body to absorb any Vitamin B12.

Cells called ‘parietal cells’ present in the stomach (gastric) mucosa produce the intrinsic factor. Thus, loss of these parietal cells over a prolonged period of time inevitably causes Vitamin B12 deficiency and malabsorption anemia.

Auto-immune (the body’s defence cells erroneously destroying the body’s own cells) antibodies have been identified which cause impaired binding of the intrinsic factor & Vitamin B12. Antibodies are also directed towards the parietal cells thus destroying them.

Other causes of Vitamin B12 deficiency are:

• Infections (bacterial overgrowth in intestines; parasitic infections)
• Nutrition (starvation; poor diet of infants; vegan diet; poor intake due to hospitalization/dentures etc.)
• Drugs {neomycin, colchicines, Para amino salicylic acid (for tuberculosis)}
• Gastrointestinal causes: Chron’s disease; celiac sprue, surgical removal of the stomach etc.

Symptoms of Pernicious anemia:

The symptoms appear very gradually with prolonged deficiency of Vitamin B12. Occasionally symptoms of nerve disorder and mental changes occur much before the laboratory changes of anemia are observed. This happens more often in elderly individuals.

Some common symptoms are:

• Getting tired very easily.
• Feeling weak always
• Tongue appears smooth, shiny, bright red and clean.
• Tingling and numbness in the hands and feet

Some other, less common symptoms of pernicious anemia are:

• Unsteadiness in walking, imbalance.
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• Confusion
• Changes in sensations of taste and smell
• Bleeding gums
• Changes in vision.
• Changes in the gastrointestinal tract:
  • smooth appearance of the tongue;
  • Changes in bowel habits (constipation or diarrhea)
  • Nausea vomiting
  • loss of appetite & weight loss
  • sensations of bloated feeling in the abdomen, fullness or gas in abdomen
  • Persistent heartburn.
• Infants with the deficiency show failure to thrive
• Dizziness / vertigo when attempting to stand up
• Pale appearance / yellowish (jaundiced) appearance of the skin
• Feeling feverish or actually having constant low-grade fever.

Please remember that pernicious anemia can also present with most other symptoms of nutritional anemia, namely

• Rapid heart beats
• Headaches
• Ringing in the ears
• Chest pains on exertion
• Breathlessness on exertion

If untreated, pernicious anemia can progress towards heart failure or even severe irreversible nerve damage. Diseases commonly associated with pernicious anemia

• Addison’s disease
• Type 1 diabetes mellitus
• Grave’s disease
• Chronic thyroiditis
• Myasthenia gravis
• Disorders of Underactive pituitary gland
• Underactive parathyroid
• Vitiligo
• Secondary amenorrhea

Diagnosis of Pernicious anemia:

A detailed clinical history, physical exam, and laboratory investigations are sufficient to diagnose the presence of pernicious anemia.

Laboratory tests and clinical exams together reveal the severity of the disease and the appropriate mode of treatment. More often, anemia is an incidental finding and the deficiency itself causes no symptoms in the patient. In fact, it is often unexpectedly discovered in a routine check-up.

• Complete blood count: for demonstration of megaloblastic anemia (where the red blood cell sizes are increased)
• Schillings test: used to test the fragility of the red blood cells.
• Biopsy specimen from a gastroscopy: to rule out atrophic gastritis known to cause pernicious anemia.
• Reticulocyte count: low counts are suggestive of pernicious anemia.
• Bone marrow biopsy: only needed when the diagnosis is uncertain
• Serum LDH: found to be raised in megaloblastic anemias.

Also performed, are tests to check Serum Vitamin B12 levels:

• Vitamin B12: The level of vitamin B12 in the bloodstream may be normal or borderline even when the total amount of B12 in the body is low.
• Folic acid (folate): This is another B vitamin that can be low when the B12 level is low. A lack of folic acid can also cause anemia.
• Homocysteine: Homocysteine is high in anemia due to the lack of vitamin B12 or folic acid. Folate deficiency is more common because this vitamin is used up more quickly and the dietary need is greater. In this case, the blood’s B12 level can be normal.
• Methylmalonic acid: The level of Methylmalonic acid is high in anemia due to a lack of vitamin B12 or folic acid. Methylmalonic acid can also be checked with a urine test.

Treatment options available for Pernicious anemia:

Conventional treatments

As pernicious anemia is a form of Vitamin B12 deficiency, the treatment of choice is to provide adequate Vitamin B12 through supplements. This is done either by

• Injections of Vitamin B12 or
• Oral supplements (2-4 mg) of Vitamin B12 daily.

Homeopathic treatment

Use of Vitamin B12 is a part of homeopathic treatment. That apart, homeopathic medicines can act as efficient immune-modulators. Auto-antibody production against the intrinsic factor and subsequent destruction of the parietal cells can be prevented by homeopathic medications. Homeopathic medicines target at the factors leading to pernicious anemia. Homeopathic treatment is recommended for Pernicious anemia.