Diseases in the body caused by vitamin B12 deficiency have several medical names:
Anemia due to B12 deficiency
- Birmer-Addison disease
- Pernicious anemia.
History of the disease
The clinical history of this type has its roots in 1855, when the British physician Addison gave a detailed explanation of this disease, and in 1872 the German doctor Birmer added a description of this pathology, and then the deficiency of vitamin B12 was characterized as anemia , which is evil.
At that time there were no methods for the correct diagnosis of the pathology, as well as a qualified treatment, so that the hemoglobin dropped to 30.0 and below g / l, the person fell into a coma, which was fatal.
Only in the 20th century in 1926, a discovery was made, which was evaluated by Nobel Prize winner Paremy, who Anemia with vitamin B12 deficiency is the inability of the stomach organ to produce a specific enzyme that helps the absorption of this vitamin from the digestive system.
Blood from anemia due to B12 deficiency
Code for ICB 10
According to the international classification of diseases of the tenth revision of the ICD-10, this pathology belongs to class D 51, “Anemia deficient in vitamin B12”.
Megaloblastic anemia of type
Pernicious anemia (with B12 deficiency), refers to the megalo-class form of anemia, and is rarely combined with another megalo-class anemia: folic deficiency.
Megaloblastic anemia is a very rare form of pathology in which there is a deviation from the normal absorption of the digestive system of folic acid, vitamin B12 and the substance of cyanocobalamin.
As a result, there is a deficiency in the body of B vitamins: B12 and B9.
Megaloblasts are modified erythrocytes that are synthesized in DNA and RNA cells. Megaloblasts appear in the cells of the bone marrow, as a consequence of a deviation in the synthesis procedure.
This is manifested in the morphological modifications of the cellular composition.
What is common and how are the 2 types of megaloblastic anemia different?
The B vitamins enter the human body with products of animal origin. In the stomach, they are associated with gastromucoprotein and are absorbed in the small intestine.
For the normal functioning of the body, the daily dose of vitamin B12 should be equal to 7 mg.
The stock of this vitamin is found in the liver, no more than 5 mg. The body’s need for folic acid is approximately 100 mcg per day.
Supply of vitamin B9 – up to 10 mg.
The violations in the synthesis of the DNA molecules lead to the inability of these cells of the bone marrow to divide quickly.
These cells include:
- Shells of the mucous system.
- Digestive tract systems
- Bone marrow cells
- Skin cells
Hematopoietic (hematopoietic) cells are cells that multiply more rapidly than others. Therefore, the indicators (reduced level of red blood cells and low hemoglobin coefficient) in the hematopoietic system characterize the first manifestations of megaloblastic anemia.
With the manifestation of anemia, these signs of hemolytic anemia are often observed:
- Pathology of thrombocytopenia: decreased index in the composition of blood platelets
- Neutropenia – a reduced neutrophil leukocyte count
- Agranulocytosis of blood pathology – a decrease in the leukocyte index
- Monocytosis disease – a decrease in monocyte molecules
- Decreased reticulocyte synthesis.
Difference and relationship between B9 folic acid deficiency anemia and vitamin B-B12 deficiency:
- Vitamin B12 participates in the synthesis of folic acid molecules. The acid is part of the thymidine molecule, which is a component of the DNA molecule. With the coordinated work of these components, and with the necessary amount for a biochemical reaction, the normal formation of blood cells and cells for the normal functioning of the digestive tract occurs.
- The functional responsibilities of vitamin B12 are to help the synthesis and breakdown of fatty acids in the body. With a deficiency of cyanocobalamin molecules, an alteration in the coordinated reaction occurs and methyl malonic acid is deposited, which has a detrimental effect on the atoms of the neurons. There is also a decrease in the synthesis of myelin, which forms a membrane for nerve cell fibers.
Folic acid does not participate in the decomposition of fatty acids and does not participate in the formation of membranes for nerve fibers.
With a deficiency of vitamin B12, the doctor prescribes the use of medications with folic acid, then activates the erythropoiesis, but only until this acid becomes excessive in the body.
The folic acid overdose occurs:
- Disorder in the nervous system.
- Degenerative changes in the bone marrow.
- Sclerosis combined with loss of motor functions.
- Funicular myelosis
Symptoms of anemia
The symptoms of anemia deficient in B12 and folic acid (as well as its absence) are classified according to the following instructions in the manifestation of the pathology:
- Anemic syndrome in the blood system.
- Gastroenterological symptoms – disorders of the digestive tract
- Neurological nature
- Symptoms in violation of the structure of the brain.
The classification of the anemic direction is manifested in the following symptoms:
- Strong head spin
- Weakness of the whole body
- Fainting condition
- Frequent contraction of the heart muscle (sinus tachycardia)
- Short of breath
- Chest pain
- Uncertainty in the perception of objects by the organs of sight.
- Yellow color of the skin (the tone gives a high level of bilirubin in the blood).
- Unreasonable absence in need of food
- Acute weight loss
- Severe nausea that passes into the vomiting compartment of the body.
- The process of inflammation of the oral cavity.
- Burning sensation in the tongue.
- The tongue acquires a crimson tone.
- Birmer anemia – Addison-Birmer disease
- Tingling in the fingers and toes
- Feeling of constant cold
- Tremors in movement
- Numbness in the lower extremities.
- The sensitivity of the skin disappears.
- Difficulties in movement.
Deviations in the brain from this type of anemia, as well as disorders in the work of the spinal cord:
- Memory loss
- Lost condition
- Sensation of constant irritation.
- Condition of coma
- Muscle cramps.
With anemia, vitamin B12 deficiency and iron deficiency anemia, there are signs of severe hypoxia in the body:
- Pale skin tone
- Peeling on the skin
- Angina pectoris
- Pain in the sternum.
Forms of development
The pathogenesis of anemia with the insufficient disappearance of vitamin B molecules in the body, ie, B12 and B9, which affects the level of hemoglobin molecules, which is found in red blood cells and is responsible for the supply of atoms of oxygen to all the cells of the human body.
Anemia is divided into forms by index in the blood plasma composition of the hemoglobin molecules.
The lower the hemoglobin index, the more severe is the course of the poor pathology:
- Easy development and course phase: hemoglobin index from 90.0 to 110.0 grams per liter of biological fluid
- Average severity: hemoglobin index of 70.0 to 90.0 grams per liter of blood plasma
- The serious stage of the course of this pathology: the red pigment coefficient does not exceed 70.0 and decreases even below this indicator.
Normative indicators of the amount of hemoglobin in the blood of men – 130.0 – 160.0 g / l.
For women, the standard – 120.0 – 135.0 g / l.
B12 deficient anemia in children
The main types of etiology of anemia with the lack of this vitamin in childhood are:
- Changes in the baby’s microflora.
- It is not enough in a child’s body for this vitamin.
- Presence in the body of worms.
- Castle factor in the period of intensive growth of the child.
The clinical indicators and the manifestations of this type of pathology are similar to the symptoms of an adult person, but there are characteristic symptoms in the children’s body:
- Strong tooth decay from a young age.
- Permanent stomatitis, which begins in childhood.
- Changes in the eyeball.
- Changes in the nail plate – the plaque is weak, fragile
- Disturbance of attention and intellect – poor school performance.
When decoding the results of the clinical laboratory these values:
- Low hemoglobin index
- Reduced number of erythrocyte molecules
- The chromaticity index increases, by more than 1.5.
- In erythrocyte molecules, Kebot’s rings, as well as Jolly’s body, are present in such a quantity that they are determined by analysis.
- Increased reticulocytes
- Increase in lymphocyte count.
- Platelets, as well as leukocytes in small amounts
- Megaloblasts were found in the biochemistry as part of the bone marrow puncture.
To help laboratory indicators, to establish a diagnosis of B12 deficiency anemia, an instrumental method is used to diagnose a child’s body:
Ultrasound of liver cells
- Ultrasound of spleen cells
- Gastroendoscopy of the alimentary tract and intestines.
- Irrigoscopy of the thin part in the intestine.
- Colonoscopy – check the condition of the colon.
The treatment of anemia in a child with B12 deficiency consists of saturating the cells of the body with these vitamins. Course of vitamins of the drug 15 calendar days.
A diet rich in calories was also designated, in which there are foods with vitamin B12 and folic acid.
To replenish the vitamin molecules in the body, a drug called cyanocobalamin is prescribed. The initial dose of this tool is 30.0 mcg to 50.0 mcg, with daily intake.
This medicine is injected intravenously.
The dose is calculated by the treating doctor individually. The medical course is carried out in children under the strict control of a specialist.
After the end of the course of treatment for prophylactic purposes and as supportive treatment, 100.0 – 250.0 mcg 2 times per month.
Regulatory indicators of vitamin cyanocobalamin in the body of children:
Vitamin B12 benefits the body when absorbed in the intestines. For this absorption to occur, an enzyme produced by the inner sections of the stomach is needed: the Castle enzyme.
Without the formation of the enzyme, the molecules of vitamin B12 are eliminated outside the body without entering it by biochemical processes, by means of faeces.
With B12 deficiency anemia, the Casla enzyme is not synthesized in the stomach, so the vitamin that is ingested in food is also not absorbed through the intestines.
In the liver cells there is a supply of vitamin B12 molecules, which, if reasonably used, can be enough for 5 calendar years. As a result, anemia occurs after a time, after the stomach has stopped producing this factor.
The lack of a Castle factor is the main cause of the pathology of B12 deficiency anemia.
The following factors cause the lack of cyanocobalamin:
- Low in foods with vitamin B12 (root cause). Cyanocobalamin is found in products of animal origin. Vegetarianism is the main risk factor for B12 deficiency in foods.
- The function of the castle factor is violated.. When the atrophy of the cells of the mucous membranes, the functionality of the internal factor does not manifest, or its decrease occurs. This cause of atrophy is genetic, congenital, with gastritis of the stomach, when the stomach is exposed to toxic elements (intoxication of the body), as well as the effect on the factor of antibodies.
- The absence, or partial loss of receptors that are necessary for the factor.. This pathology develops in Crohn’s disease, in neoplasms of the small intestine (cancer), in tuberculosis, in intestinal infantilism and in enteritis in the chronic stage of the pathology.
- Absorption of B12 molecules by worms and pathogens.. It is necessary to treat this pathology with a therapy against competitors that absorb cyanocobalamin.
- In the pathology of the pancreas.. With this pathology, there is a deviation in the breakdown of the protein protein, which is the factor binding with vitamin B12.
- Hereditary genetic congenital anomaly – This is a reduced indicator in the body of the transcobalamin synthesis, which leads to the disruption in the transport of cyanocobalamin molecules in the cells of the bone marrow.
For anemia due to folic deficiency, the etiology with food is not adequate, because vitamin B9 is present in all products of plant and animal origin. This vitamin B group does not need the help of a factor and is absorbed independently.
Folio deficiency problems begin when the following causes appear in the body:
- Bad diet
- Low food consumption
- The old age of the patient, at this age there is a difficult digestibility of the vitamins of the food.
- Reception of alcoholic beverages. When addiction to alcohol, a person can not eat completely
- Pathology in the intestines that does not allow the body to absorb vitamins.
- Crohn’s disease
- Blood count
- Pathology of celiac disease
- Malignant neoplasms in the intestinal regions.
- Increased need for vitamin B12 and folic acid in women during fetal development of the baby. In pregnant women, the food intake of these products should be increased to avoid fetal hypoxia.
- Increase of B9 consumption in psoriasis pathology.
- When taking anticonvulsant medications, deficiencies of vitamin B9 and B12 occur.
Vitamin deficiency comes when medication is taken.
When making this diagnosis, deficient vitamin B12 anemia, the doctor first records the anamnesis during the diagnosis, when and in what circumstances the severe symptoms of the anemia appeared, with its weakness and the manifestations of pathology in the digestion process.
It is also necessary to find out if the patient has a disease that occurs in the chronic stage and also bring information about possible congenital hereditary genetic diseases.
After the anamnesis, the patient’s skin is examined and the pronounced symptoms on the skin are determined.
The doctor also measures the blood pressure index (with anemia, the pressure decreases), as well as the heart rate (often a rapid pulse).
After this inspection, on the basis of external signs, laboratory diagnoses (blood tests) are designated, as well as a list of instrumental exams:
- General blood test
- Biochemical analysis of blood.
- Urine for general analysis.
- Puncture of bone marrow
- Electrocardiography (ECG)
- Ultrasound of the liver and spleen.
- Bowel ultrasound
- Ultrasound of the stomach.
When deciphering the general analysis, you see the image of the whole blood, the indicators of each element in its composition. In this analysis, vitamin B12 deficiency anemia shows a decrease in red blood cell molecules, as well as a reduced synthesis of reticulocytes.
The level of red pigment (hemoglobin) is reduced, and platelets are also reduced, which causes hypoxia. The color increases with anemia and reaches more than 1.50 (at a rate of 0.860 – 1.050).
In the analysis observed, the presence of proteins in the urine, and the possible detection of comorbidities.
Biochemistry is the most valuable analysis to identify deviations in the structure and composition of blood.
In the composition of the biochemistry are detected with B12 anemia deficient such indicators:
- Often the rate of high cholesterol due to anemia
- Presence of creatinine
- Glucose in the blood
- Uric acid
- Electrolytic indicators of calcium, potassium and sodium molecules.
- Lactate dehydrogenase is an enzyme in the composition of liver cells that promotes absorption by iron cells. Indicator of biological reactions for the synthesis of erythrocytes and hemoglobin.
- The B vitamins are reduced. The B12 index is low.
The blood hemogram shows the hematocrit number, the percentage of all types of leukocytes: the leukocyte formula has been established.
The myelogram, or the indicators of bone marrow puncture, determines the level of production of erythrocyte molecules, as well as the megaloblasts in the blood, confirming the megaloblastic nature of blood formation in the human body.
The instrumental technique determines the deviations of the standard indicators of the structure of the internal organs, as well as reveals violations in their functionality.
Therapy for deficient B12 anemia
The treatment of anemia due to vitamin B12 deficiency begins with the treatment of the root cause of this deficiency: it is a medical therapy for the destruction of worms, normal and balanced nutrition, as well as a surgical technique to treat a neoplasia malignant
For the complex treatment of anemia, drug B12 is administered to the body in a dose of 200.0 mcg – 250.0 mcg per day. The drug is injected intramuscularly or injected under the skin of the human body.
If the anemia affected the centers of the nervous system, then the scheme of drug therapy is as follows: during the first 3 calendar days, the dose of the vitamin is 1000 mcg per day and the subsequent treatment is according to the prescribed scheme. The treatment regimen and the dose of B12 are prescribed by the attending physician and depend on the degree of deficiency in the body of vitamin B12, which caused anemia.
After the stabilization in the body of this vitamin, to keep it at a normal level, the drug B12 is used in the treatment of 100.0 mcg – 200.0 mcg 1 time per calendar month.
Clinical recommendations for rapid replacement in the blood composition of red blood cells: the introduction of the mass of red blood cells intravenously, which can restore the destroyed balance in the composition of the blood plasma of the human body.
Anemia due to complicated B12 deficiency
If you do not take emergency measures in treatment, the consequences of this type of anemia can be quite serious and pose a threat to the patient’s life:
- Coma, In which the patient does not respond to external stimuli. Coma can occur because of brain hypoxia with anemia and can cause death.
- Severe anemia, that significantly worsens the condition of the body and triggers irreversible effects on it. This degree occurs when the hemoglobin index is less than 70.0 g / l
- Funicular myelosis – This is an injury to the cells of the spinal cord, as well as nerve endings in the peripheral parts of the body. The defeat of the connective nerve fibers of the spinal cord with the centers of the brain, as well as with all internal organs and bodily systems. With these violations, the sensitivity of the limbs decreases, there is a lack of movement and the period of progression of myelosis: the sensitivity disappears completely and the person is not able to perform independent movements.
- Cell disruption, which later leads to the non-functionality of this organ (the cells of the heart, the liver and the spleen, the digestive tract, the renal cells, the respiratory system are affected).
If the treatment process starts too late, complications in the nervous system can not be restored. These destructions are irreversible.
Prevention is mainly aimed at improving the consumption of B12 through products:
- The use of animal products with a large number of them B12.
- Timely treatment of pathologies that can cause B12 deficiency and cause anemia.
- After surgery on the organs of the digestive tract, take medications to maintain the level of this vitamin.
Foods rich in vitamin B12
Diet for this form of anemia.
A balanced diet is especially necessary in the period of prenatal development of the child, since the formation of the baby depends on the intake of vitamins in the body of a pregnant woman, as well as the appearance of intrauterine pathologies that will manifest after birth.
During pregnancy, the need for vitamin B12 increases by 50.0%.