Pernicious Anemia Treatment in Indore

Pernicious Anaemia – Detailed Description

Pernicious anaemia (PA) is a type of megaloblastic anaemia caused by vitamin B12 deficiency due to the body’s inability to absorb B12 properly.

It is an autoimmune disorder in many cases, where the immune system attacks intrinsic factor (IF) or parietal cells in the stomach, both of which are essential for B12 absorption.

Vitamin B12 is important for:

Red blood cell formation

Nervous system functioning

DNA synthesis

Without adequate B12, the body develops abnormally large red blood cells (megaloblasts) that cannot function properly.

Causes & Risk Factors

1. Autoimmune Destruction

Antibodies attack intrinsic factor or stomach parietal cells

This impairs B12 absorption from the gut.

2. Gastrointestinal Disorders

Atrophic gastritis

Gastrectomy or surgery affecting the stomach/ileum

Crohn's disease or celiac disease can impair B12 absorption

3. Nutritional Deficiency

Rarely, strict vegan diets without supplementation can contribute to

4. Genetic Factors

Family history of autoimmune diseases increases the risk factor.

5. Age

Most common in adults over 60

How Pernicious Anaemia Affects the Body

Lack of B12 disrupts DNA synthesis in bone marrow → large, dysfunctional red blood cells.

Reduced oxygen-carrying capability → anaemia → fatigue and pallor.

Nervous system damage due to impaired myelin synthesis → neuropathy, cognitive issues.

Gastrointestinal effects include anorexia, diarrhoea, and weight loss.

Symptoms

Hematologic Symptoms

Fatigue, weakness

Pale or jaundiced skin

Shortness of breath

Racing heartbeat (palpitations)

Neurological Symptoms

Tingling or numbness in hands and feet-peripheral neuropathy

Muscle weakness

Difficulty walking or problems with balance

Memory loss, confusion, or mental decline

Mood changes-depression, irritability

Gastrointestinal Symptoms

Lack of appetite

Weight loss

Nausea or diarrhoea

Other Symptoms

Swollen, red tongue (glossitis)

Mouth sores

Digestive unease

Complications: If untreated,

Severe anaemia → heart failure

Irreversible nerve damage → permanent neuropathy

Increased risk of developing gastric cancer secondary to chronic atrophic gastritis

Diagnosis

1. Blood Tests

Complete blood count (CBC) → large red blood cells (MCV high)

Low serum B12

Elevated homocysteine and methylmalonic acid (MMA)

2. Antibody Tests

Anti-intrinsic factor antibodies

Anti-parietal cell antibodies

3. Bone Marrow Examination

Rarely indicated; demonstrates megaloblastic changes

4. Further Investigations

Gastric biopsy, if atrophic gastritis is suspected

Treatment

1. Vitamin B12 Replacement

Parenteral (injections): Cyanocobalamin or hydroxocobalamin

Initial: daily or weekly until levels normalise

Maintenance: monthly injections lifelong

Or, in some instances, high-dose oral B12

2. Folate Supplementation

Only if deficient, but must ensure B12 is corrected first to prevent neurological worsening

3. Address Root Cause

Monitor for gastric issues or autoimmune conditions

4. Symptom Management

Fatigue: gradual increase in activity as haemoglobin improves

Neuropathy: physiotherapy and supportive care

Lifestyle & Supportive Care

Balanced diet with B12-rich foods (meat, eggs, dairy)

Regular check-up of B12 levels

Avoid alcohol and medications that interfere with B12 absorption (e.g., long-term metformin, proton pump inhibitors). Integrative approaches (Yoga, stress management) may improve general well-being. Prognosis: With early diagnosis and lifelong B12 supplementation, patients usually recover fully. Neurological symptoms may persist or become permanent if treatment is delayed. Regular monitoring is essential to prevent recurrence and complications.