Fatigue, dizziness, neurological problems… Could it be pernicious anaemia?

What is pernicious anaemia (Biermer’s disease)? What causes it, and who is at risk?

Pernicious anaemia, also known as Biermer’s disease, is a type of anaemia caused by vitamin B12 deficiency. Specifically, it occurs when the body cannot absorb enough vitamin B12 due to a lack of intrinsic factor, a protein made in the stomach that is essential for B12 absorption in the small intestine.

This issue stems from an autoimmune reaction in which the immune system mistakenly attacks the stomach’s parietal cells or intrinsic factor itself. As a result, vitamin B12 from food cannot be absorbed, even if dietary intake is sufficient. Over time, this leads to a deficiency that disrupts the production of red blood cells and can also affect the nervous system.

Pernicious anaemia is therefore not the cause of vitamin B12 deficiency in general, but rather a specific condition resulting from an autoimmune-driven B12 deficiency. It often occurs alongside other autoimmune diseases, such as Hashimoto’s thyroiditis or type 1 diabetes.

In addition to autoimmunity, other contributing factors include chronic atrophic gastritis, Helicobacter pylori infection, a family history of the condition, or previous gastric surgery that may have altered the digestive tract’s ability to absorb nutrients.

What are the symptoms of pernicious anaemia?

The symptoms of pernicious anaemia can vary and may affect many parts of the body. Commonly, individuals experience severe fatigue, pale skin, breathlessness, and dizziness. These symptoms are related to the body’s reduced ability to produce sufficient healthy red blood cells.

Neurological symptoms are also frequent and may include tingling or numbness in the hands and feet, balance issues, memory problems, or difficulty concentrating. These occur because vitamin B12 is vital for maintaining healthy nerve function. Without enough of it, the nervous system begins to suffer, and in some cases, these changes can become irreversible if left untreated.

Some people also report digestive symptoms, such as bloating, diarrhoea, or constipation. A condition known as Hunter’s glossitis may develop, where the tongue appears red, smooth, and painful due to inflammation.

Additionally, mood disturbances such as irritability or depression can be linked to vitamin B12 deficiency.

How is pernicious anaemia diagnosed?

Diagnosing pernicious anaemia typically involves a combination of blood tests and clinical evaluations. A blood test is used to check vitamin B12 levels, which are usually significantly low in affected individuals. A complete blood count may reveal macrocytic anaemia, where red blood cells are abnormally large.

Immunological testing can help detect antibodies against intrinsic factor or the stomach’s parietal cells, confirming the autoimmune nature of the disease. In some cases, a gastroscopy along with a gastric biopsy may be performed to assess for chronic atrophic gastritis, a condition frequently associated with pernicious anaemia.

What is the treatment for pernicious anaemia?

The standard treatment for pernicious anaemia involves vitamin B12 supplementation, most often through intramuscular injections. This method bypasses the absorption problem in the digestive system and delivers the vitamin directly into the body. Initially, injections are given frequently to restore normal levels. Once stabilized, patients typically continue with a maintenance schedule of one injection per month. In certain cases, if absorption in the gut is still partially functional, oral vitamin B12 supplements may be considered as an alternative.

However, diet alone is not sufficient to correct the deficiency in most cases. Even though foods rich in B12, like meat, fish, eggs, and dairy, are helpful, they won’t be enough without medical intervention due to the underlying absorption issue.

Ongoing medical supervision is essential to monitor the condition and prevent complications. Blood tests will track progress and ensure that treatment remains effective over time.

Can pernicious anaemia be prevented?

There is no guaranteed way to prevent pernicious anaemia, especially when it arises from an autoimmune response. However, early detection among high-risk individuals can help prevent serious complications. People with autoimmune diseases or a family history of pernicious anaemia should undergo regular medical check-ups and vitamin B12 screenings when appropriate. Prompt recognition and management can make a significant difference in outcomes.

Living with pernicious anaemia

With appropriate medical care, people living with pernicious anaemia can lead full, active lives. Adhering to the prescribed treatment plan, especially maintaining regular B12 injections, is crucial for avoiding a recurrence of symptoms and protecting the nervous system from long-term damage.

It’s important for patients to listen to their bodies and report any signs of a persistent or returning deficiency to their healthcare provider. With regular follow-up and monitoring, the condition can be well-managed, and quality of life can remain high.

Conclusion

Though pernicious anaemia is a chronic condition, it is highly treatable with proper vitamin B12 supplementation. Since the disease is autoimmune in nature, ongoing monitoring is necessary to prevent complications, particularly those affecting the nervous system. Early diagnosis and consistent treatment allow individuals with pernicious anaemia to manage their health effectively and live without major limitations.

Did you find this article helpful?

Give it a “Like” and share your thoughts and questions with the community in the comments below!

Take care!