B12 deficiency anemia (megaloblastic, pernicious, Biermer's disease) - a disease characterized by impaired hematopoiesis process due to deficiency of vitamin B12. It manifests itself mainly bone marrow abnormalities, nervous system and gastrointestinal tract.
Why disease develops
Hemoglobin - a protein that makes up red blood cells - red blood cells. Its function is to transport oxygen to the cells and elimination of carbon dioxide. With a lack of red blood cells and inhibition of the function of hemoglobin developing anemia.
Depending on the etiological factors and clinical manifestations are different types of anemia. Megaloblastic anemia (it pernicious anemia) occurs due to deficiency of vitamin B12 or folate - substances that are actively involved in the synthesis of new red blood cells in the body. The mechanism of development of this disease manifests a change in the shape and size of the increase in red blood cells.
Causes of B12 deficiency anemia:
- Insufficient production of a specific protein in the stomach, through which the vitamin B12 is able to be absorbed into the blood (Factor Castle). This kind of anemia called pernicious (Addison-Birmera disease). However, this form lends itself well to therapy.
- Surgical removal of the ileum, in which the absorption of vitamin B12, or the stomach, a factor which is synthesized Castle.
- Insufficient intake of vitamin B12 from animal products (meat, fish, milk, seafood). The most common reason for this suffering from anemia B12 vegetarians.
- intestinal pathology that leads to malabsorption of nutrients (Crohn's disease, ulcerative colitis).
- Receiving drugs that reduce stomach acidity (proton pump inhibitors).
- Violation Incoming mechanism vitamin B12 into the cell during its normal intake.
- Conditions in which the need for vitamins exceeds its delivery into the body (pregnancy, parasitic diseases).
Symptoms and how to detect disease
As a result, there is reduced supply of anemia cell oxygen. This leads to fatigue, weakness, dizziness and fainting, ringing in the ears, pale skin and mucous membranes, shortness of breath, palpitations, loss of appetite and body weight.
There are three large syndrome, which includes the main symptoms of megaloblastic anemia:
- anemic syndrome. Appears weakness, dizziness, syncope, tinnitus, flashing "flies" in the eyes, shortness of breath, tachycardia, tingling in the chest.
- Gastroenterology syndrome. Characterized by a decrease in appetite and weight gain, nausea, vomiting, constipation, burning and discoloration (magenta) tongue (glossitis).
- Neurological syndrome. It includes signs of a lesion of the peripheral nervous system, such as numbness and tingling of extremities, unsteady gait, muscle weakness. With prolonged and pronounced deficiency of vitamin B12 may develop lesions spinal cord and brain, which manifests itself in the loss of vibration sensation in the legs, cramps.
Kinds
According to the International Classification of Diseases (ICD-10) are the following types:
- D51.0 - Castle's intrinsic factor deficiency, leading to anemia, Addison-Biermer (pernicious anemia);
- D51.1 - malabsorption in conjunction with the release of protein in the urine (proteinuria);
- D51.2 - pernicious anemia, symptoms of which are onemenenie or tingling of extremities (due to failure of transcobalamin II);
- D51.3 - anemia associated with food;
- D51.8 - other types of B12 deficiency anemia;
- D51.9 - megaloblastic anemia, unspecified.
degrees
Clinical signs of B12 deficiency anemia is an indication for the laboratory blood tests.
The main criterion for classification of anemia severity is the content of hemoglobin in the blood. Depending on the level of hemoglobin distinguish such degrees:
- light (blood hemoglobin content of from 90 to 110 g / l);
- mid-weight (hemoglobin 90 to 70 g / l);
- heavy (hemoglobin less than 70 g / l).
The normal level of hemoglobin in blood is 130-160 g / L for males and 120-150 g / L in women. Hemoglobin 110 to 120 g / l is intermediate between normal and anemia.
Symptoms of B12 deficiency anemia may not yet appear, while the already visible disturbances in the blood. The diagnosis of megaloblastic anemia is put mainly on the blood picture.
diagnostic measures
Pernicious anemia is a number of specific clinical symptoms and changes in laboratory analysis, so its diagnosis is not a big difficulty for hematologists.
Upon detection of a typical triad of anemia, gastrointestinal and neurological syndromes assigned study hemogram and myelogram.
In peripheral blood following characteristic changes occur in this disease:
- color index above 1.0 (hyperchromic);
- the number of erythrocytes is reduced to a greater extent than the level of hemoglobin;
- content and hemoglobin concentration increased;
- macrocytosis - large hyperchromic red blood cells in a blood smear are determined;
- anizopoykilotsitoz - modified erythrocytes are detected (droplet) form;
- basophilic stippling of red blood cells;
- erythrocytes containing calf Jolly, calf Kebota;
- platelet anisocytosis;
- hypersegmentation neutrophil nuclei;
- single erythrokaryocytes, megaloblasts;
- reducing the number of reticulocytes;
- the majority of patients have leukopenia and thrombocytopenia - reduction in the number of white blood cells and platelets.
The following lesions are found in the bone marrow:
- hyperplasia of the red sprout with Megaloblastic type of hematopoiesis;
- promegaloblasty, megaloblasts;
- asynchronous maturation of the nucleus - cytoplasm oxyphilous kernel - immature;
- cell division (mitosis);
- Kebota calf and calf Jolly in red blood cells;
- changes in the granulocytic series: giant metamyelocytes and stab.
A single injection of vitamin B12 result in complete transformation type megaloblastic hematopoiesis in normoblastny so therapeutic course is not recommended until the sternal puncture, or bone marrow study will uninformative.
Additional studies that may help in the diagnosis of deficiency anemia:
- determining the level of bilirubin in the blood - detects elevated indirect bilirubin;
- LDH level - increasing;
- FEGDS with biopsy - atrophic gastritis;
- to monitor the effectiveness of therapy and differential diagnosis is carried out re-determination of the number of reticulocytes in the blood for 6-7 Day care (must be an increase in their number - "retikulotsitarny crisis," which is a measure of the efficiency and accuracy diagnosis).
To distinguish the disease must first of folic acid deficiency anemia. These two diseases have the similarity of clinical and laboratory manifestations of what used to pernicious anemia (Addison-Birmera disease) called B12, folic acid.
Immediately confirm or refute the diagnosis of folic acid deficiency anemia can be by determining the level of serum folate. Its reduction is the basis for the establishment of the diagnosis. But such a study is not available in many institutions. Therefore, increasingly resorting to the tactics of gradual administration of vitamin B12 and folic acid.
Treatment
disease treatment may be performed as outpatient or in the hospital, depending on the severity of the patient's condition.
drugs
Therapy megaloblastic anemia of unspecified origin begins with administration of vitamin B12. Cyanocobalamin solution is administered in a daily dose of 500 mg intramuscularly daily for 2 weeks. If at the end of the first week does not come "retikulotsitarny crisis" - the most likely diagnosis of folic acid deficiency anemia.
In the case of a positive result after 2 weeks of dosing at pass 500 mcg cyanocobalamin mode 1 time per week. Therapy was continued until normalization of red blood cells: hemoglobin, percentage of reticulocytes, red blood cell count.
Given that, according to present views, anemia, Addison relates to autoimmune diseases (autoimmune atrophic gastritis leads to termination of the synthesis Castle factor), pernicious anemia treatment allows to achieve only persistent hematologic remission. For maintenance of remission and relapse prevention of disease patient administering shown cyanocobalamin 1 once a month at a dose of 500 micrograms life. Such patients are subject dispensary observation hematologist.
Patients with severe neurological impairment cyanocobalamin dosage should be increased by 50% the first six months of therapy.
In severe the patient's condition - symptoms of hypoxia, circulatory failure, coma prenitsioznoy - showing the extra red blood cell transfusions.
folk remedies
In 1926 was the first time a method of therapy megaloblastic anemia appointment of a special diet containing raw calf liver.
This is best suited lean raw calf's liver, which must be twice through a meat grinder and take 200 grams before each meal.
Some other folk remedies can help ease symptoms. Some of them:
- with great weakness to take 1 tbsp. l. garlic and honey before each meal;
- decoction of red clover inflorescences take 1 tbsp. l. 3 times a day;
- broth hips take 1 glass 3 times daily after meals as a hot drink.
In modern conditions Biermer's disease respond well to treatment with synthetic preparations of vitamin B12, which are well tolerated and are inexpensive. Therefore, traditional medicine has only secondary importance. Be treated for the diagnosis of anemia B12 by any folk recipes can only be consulted with a doctor-hematologist.
Possible consequences and prognosis
The term "pernicious anemia" ( "pernicious anemia"), as mentioned earlier, has only historical value. Favorable prognosis of the disease. Despite the fact that megaloblastic anemia often runs a chronic and require life support therapeutic course, the quality of life of patients who are in remission, suffers a little. These people can lead an active life.
Outlook remains important for patients with advanced forms of anemia, accompanied by hypoxia, pulmonary heart failure and coma. These conditions require the immediate start of intensive care, a delay which can be fatal.
