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Anemia - B12 deficiency

MedlinePlus Topics

Anemia

Images

Megaloblastic anemia - view of red blood cells Megaloblastic anemia -
view of red blood cells

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Central nervous system Chronic Crohn's disease Intrinsic factor
Malabsorption Pap smear Pernicious anemia Vitamin B12

B12 deficiency anemia is a low red blood cell count due to a lack of
vitamin B12.

Causes

Vitamin B12 is essential for normal nervous system function and blood
cell production. The main sources of vitamin B12 include meat, eggs,
and dairy products. For vitamin B12 to be sufficiently absorbed by the
body, it must bind to intrinsic factor, a protein released by cells in
the stomach. The combination of vitamin B12 bound to intrinsic factor
is absorbed in the final part of the small intestine.

Causes of vitamin B12 deficiency include:

Abdominal or intestinal surgery that affects intrinsic factor
 production or absorption

A diet low in vitamin B12 (for example, a strict vegetarian diet
 that excludes all meat, fish, dairy products, and eggs)

Chronic alcoholism

Crohn's disease

Infection with the fish tape worm

Intestinal malabsorption disorders

Pernicious anemia, which is caused by the destruction of intrinsic
 factor by the immune system

The risk factors are related to the causes.

Symptoms

Confusion or change in mental status in severe or advanced cases

Decreased sense of vibration

Diarrhea

Fatigue

Loss of appetite

Numbness and tingling of hands and feet

Pallor

Shortness of breath

Sore mouth and tongue

Weakness

Exams and Tests

A physical exam may show problems with reflexes or positive Babinski
reflex.

The following tests may be done:

Bone marrow biopsy

Bone marrow examination

CBC

Schilling test

Serum LDH

Serum vitamin B12 level

Treatment

Treatment depends on the specific cause of B12 deficiency anemia.

Pernicious anemia requires lifelong vitamin B12 injections. People
with anemia due to a lack of dietary vitamin B12 may be told to take
vitamin supplements and follow a more balanced diet. Treatment may
start with vitamin B12 injections.

Anemia caused by malabsorption is treated with vitamin B12 injections
until the condition improves.

Outlook (Prognosis)

Treatment for this form of anemia is usually effective.

Possible Complications

The signs and symptoms related to the central nervous system may
 be irreversible if treatment is not begun within 6 months of when
 these symptoms begin.

Vitamin B12 affects cells that form the outer surface of the body
 and line inner passageways (epithelial cells). Therefore, a lack
 of B12 may cause a falsely abnormal Pap smear.

When to Contact a Medical Professional

Call your health care provider if you have any of the symptoms of
anemia.

Prevention

Anemia caused by a lack of vitamin B12 can be prevented by following a
well-balanced diet. B12 injections can prevent anemia after surgeries
known to cause vitamin B12 deficiency. Early diagnosis and prompt
treatment can limit the severity and complications of this anemia.

Alternative Names

Macrocytic anemia

References

Antony AC. Megaloblastic anemias. Goldman L, Ausiello D, eds. Cecil
Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap
170.

Update Date: 11/23/2008

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division
of General Medicine, Department of Medicine, University of Washington
School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow
Transplant Program, Massachusetts General Hospital. Also reviewed by
David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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