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Thread: Pernicious Anemia : Causes, Symptoms, Diagnosis, Treatment, and ...

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    Pernicious Anemia (Megaloblastic): Causes, Symptoms, Diagnosis, Treatment, ...




    General Info in Brief:

    What is megaloblastic (pernicious) anemia?

    Megaloblastic (pernicious) anemia is a rare disorder in which the body does not absorb enough vitamin B12 from the digestive tract, resulting in an inadequate amount of red blood cells (RBCs) produced.
    What causes megaloblastic (pernicious) anemia?

    Megaloblastic (pernicious) anemia is more common in individuals of northern European descent. Megaloblastic (pernicious) anemia results from a lack of intrinsic factor in gastric secretions (a substance needed to absorb vitamin B12 from the gastrointestinal tract). Vitamin B12 deficiency results.

    The inability to make intrinsic factor may be the result of chronic gastritis, or the result of a gastrectomy (removal of all or part of the stomach). Megaloblastic (pernicious) anemia may also be associated with type 1 diabetes, thyroid disease, and a family history of the disease.
    What are the symptoms of megaloblastic (pernicious) anemia?

    The following are the most common symptoms for megaloblastic (pernicious) anemia. However, each individual may experience symptoms differently. Symptoms may include:

    •weak muscles
    •numbness or tingling in hands and feet
    •difficulty walking
    •nausea
    •decreased appetite
    •weight loss
    •irritability
    •lack of energy or tiring easily (fatigue)
    •diarrhea
    •smooth and tender tongue
    •increased heart rate (tachycardia)
    The symptoms of megaloblastic (pernicious) anemia may resemble other blood conditions or medical problems. Always consult your physician for a diagnosis.
    How is megaloblastic (pernicious) anemia diagnosed?

    Megaloblastic (pernicious) anemia is usually discovered during a medical examination through a routine blood test. In addition to a complete medical history and physical examination, diagnostic procedures for megaloblastic (pernicious) anemia may include additional blood tests and other evaluation procedures, including the Schilling test.

    The Schilling test is performed to detect vitamin B12 absorption. In the Schilling test, vitamin B12 levels are measured in the urine after the ingestion of radioactive vitamin B12. With normal absorption, the ileum (portion of the small intestine) absorbs more vitamin B12 than the body needs and excretes the excess into the urine. With impaired absorption, however, little or no vitamin B12 is excreted into the urine.
    Treatment for megaloblastic (pernicious) anemia:

    Specific treatment for megaloblastic (pernicious) anemia will be determined by your physician based on:

    Foods that are rich in folic acid include the following:

    •orange juice
    •oranges
    •romaine lettuce
    •spinach
    •liver
    •rice
    •barley
    •sprouts
    •wheat germ
    •soy beans
    •green, leafy vegetables
    •beans
    •peanuts
    •broccoli
    •asparagus
    •peas
    •lentils
    •wheat germ
    •chick peas (garbanzo beans)

    Treatment
    Medical Care

    Most patients with megaloblastosis are treated with cobalamin and folate therapy to treat deficiencies in these substances. Transfusion therapy should be restricted to patients with severe, uncompensated, and life-threatening anemia. Because megaloblastic anemias usually develop gradually, most patients have adjusted to low Hgb levels and do not require transfusions.


    • Cobalamin (1000 mcg) should be given parenterally daily for 2 weeks, then weekly until the hematocrit value is normal, and then monthly for life. This dose is large, but it may be required in some patients. Patients with neurological complications should receive cobalamin at 1000 mcg (more in some cases) every day for 2 weeks, then every 2 weeks for 6 months, and monthly for life.
    o Oral cobalamin (1000 mcg) can be administered to patients with hemophilia (to avoid intramuscular injections) and to patients with severe malnutrition or those who have abnormalities in the terminal ileum. Doses and schedules differ in recent publications. However, oral dosages should be monitored for desired response, since absorption can be variable and may be insufficient in some patients.
    o It may be practical to initially administer parenteral cobalamin to a patient with vitamin B-12 deficiency and then to continue treatment with oral cobalamin. Oral cobalamin is cost effective and better accepted by patients.

    • Folate (1-5 mg) should be administered orally. If this is difficult, comparable doses can be administered parenterally.

    • Therapeutic options when the etiology of megaloblastosis is uncertain include therapeutic doses of both cobalamin and folate after serum level measurements for cobalamin and folate levels, bone marrow, and other studies have been initiated. The Schilling test is not affected by previous therapy. Another option is to administer a trial of a physiological dose of folate. Cobalamin deficiency does not respond to daily folate doses of 100-400 mcg (physiological dose), but this dose results in complete response in patients with folate deficiency. Under no circumstances should therapeutic doses of folate (1-5 mg/d) be administered without cobalamin. The reason is that folate therapy corrects the anemia, but folate does not correct a cobalamin-induced neurological disorder and thus results in the progression of neuropsychiatric complications.

    • Prophylactic folate therapy (1 mg/d) should be administered during pregnancy and the perinatal period to meet the increased demand for folate by the fetus and during lactation. Folate should also be given daily to patients with chronic hemolysis. Folate therapy is currently recommended for individuals with high levels of homocysteine who have a propensity for thromboembolic disease to prevent this complication. Multivitamins that contain folate have been recommended for elderly persons.
    o Fortification of foods with folic acid has been recommended to prevent hyperhomocysteinemia-related thrombosis, folate deficiency–related neoplasia, and pregnancy-related fetal abnormalities.
    o However, opponents to the fortification plan are concerned that folate-fortified foods given to patients with unrecognized cobalamin deficiencies will increase the frequency of cobalamin-induced neuropsychiatric disorders.

    • Cobalamin therapy can be beneficial for patients with borderline cobalamin deficiency or in patients who present with only neuropsychiatric disorders. The role of minimal cobalamin deficiency in patients with borderline neuropsychiatric dysfunction has recently been recognized because of more sensitive tests and a greater awareness of this potential problem. One cause of borderline cobalamin deficiency is food-cobalamin malabsorption, described in the protein-bound absorption test discussion. Treatment with 50 mcg of oral cyanocobalamin daily can restore cobalamin stores in these patients.

    • Blind loop syndrome should be treated with antibiotics.

    • Patients with TCII deficiency may require higher doses of cobalamin.

    • Tropical sprue should be treated with cobalamin and folate.

    • Acute megaloblastic anemias due to nitrous oxide exposure can be treated with folate (5 mg/d) and cobalamin (1 mg IM).

    • Fish tapeworm infection, pancreatitis, Zollinger-Ellison syndrome, and inborn errors should be treated with appropriate measures.

    Foods that are rich in folic acid and vitamin B12 include the following:

    •eggs
    •meat
    •poultry
    •milk
    •shellfish
    •fortified cereals
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    Last edited by trimurtulu; 01-09-2009 at 12:08 PM.

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    Default Re: What is megaloblastic (pernicious) anemia?

    Megaloblastic anemia which is also called as Pernicious Anemia is a rare blood disorder in which the body does not absorb enough vitamin B12, which results in an insufficient amount of red blood cells in the bloodstream. Megaloblastic anemia is also associated with type 1 diabetes and thyroid disease.
    Some of the common symptoms are decreased appetite, diarrhea, pale or change in skin color, headaches, difficulty in walking, increased heart rate, weight loss, weak muscles, sore mouth & tongue, tiredness, lack of energy or tiring easily, irritability, nausea, numbness or tingling in hands or feet. These symptoms can vary person to person.

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    Anemia can be best avoided by eating a wide variety of healthy foods which are rich in iron content. Fruits such as apples, bananas, apricots and plums; vegetables such as yams, squash. Jobelyn Blood Building Formula is a powerful natural antioxidant which can also help to prevent anemia.
    Last edited by James Mark; 11-01-2011 at 08:21 PM.

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