Pernicious Anemia Symptoms and Treatment

Pernicious AnemiaThere are two vitamins – vitamin B12 and folic acid – required for the production of red blood cells in the bone marrow. The body absorbs these vitamins from some kind of food. If bone marrow supply is insufficient in one of these two vitamins, red cell production decreases and those that are produced are defective. The consequence of this is anemia.

In developed countries, almost every individual’s diet contains sufficient amounts of vitamin B12, so that the lack of that vitamin is almost always a consequence of the inability of the body to absorb it from food. The liver of healthy people contains enough vitamin B12 for three years. Inability to absorb vitamin B12 over time will significantly reduce these intake in the liver and, when this happens, anemia occurs.

There are various reasons why is the vitamin B12 absorption disrupted in some people. Before this vitamin is absorbed from the bottom of the small intestine, it must be connected to the stomach with a special chemical substance called “internal factor” and secreted by the gastric mucosa. In some people (the reasons are not completely clear), the gastric mucosa stops extracting a sufficient amount of internal factor, so that sufficient amounts of vitamin can not be absorbed. The consequence of this is a disorder called pernicious anemia.

Some types of surgical procedures on the digestive tract can cause poor or no absorption of vitamin B12. If this happens, megaloblastic anemia develops. In approximately 5% of patients surgically who had their lower part of the stomach removed – due to stomach ulcer or the duodenum urea treatment – the stomach can not produce enough internal factor. In a small number of patients who had small bowel surgery, bacteria are multiplied in the intestinal tract and interfere with vitamin B12 absorption. All patients who had the back of the small intestine (i.e. the place of absorption of vitamin B12) removed surgically, will probably suffer from this deficiency.

Lack of folic acid is almost always due to insufficient amounts of this vitamin in food – which usually means lack of green vegetables in food. The body does not have large stocks of this vitamin, so each deficiency is discovered after several weeks in the form of anemia (anemia due to the lack of folic acid or macrocytic anemia). People suffering from celiac disease are also prone to anemia due to lack of folic acid, since they can not absorb enough vitamins (even when they have enough nutrition).

Both types of anemia cause general weakness associated with all anemia, but pernicious anemia is heavier because vitamin B12 is needed not only for producing red blood cells, but also essential for maintaining the nervous system. Therefore, due to the lack of B12, various parts of the nervous system, especially the spinal cord, may be damaged, which will cause additional symptoms.


The main symptoms of anemia due to lack of vitamin B12 or folic acid are, at the same time, the symptoms of other types of anemia – blurriness, exhaustion, shortness of breath and heartburn (especially after strain). In all types of anemia, warts often appear in the mouth and in the tongue.
In pernicious anemia, other symptoms are possible – skin soreness, poor digestion, abdominal pain, loss of appetite and weight loss. Since the spinal cord is often affected, the patient will not be able to walk or maintain a normal balance, and can permanently feel “mud” in the hands and feet. In addition, partial loss of memory, disturbance and depression may occur.


Pernicious anemia affects one in 2500 people. It is equally common in men and women, rarely occurs before the age of 40, and is most common in persons over 50 years of age. If you have a close relative, who has a lack of internal factor causing the disease, you are at risk of being overwhelmed by such anemia.

Anemia due to lack of folic acid is somewhat more common than pernicious anemia. It is revealed in 10% of the elderly receiving hospitalization, usually due to poor diet. It also occurs in pregnant women who need additional supplies for the development of the cats. Up to 3% of women waiting for one child and 10% of twin-looking women are suffering from a mild form of anemia due to lack of folic acid.


Pernicious and macrocytic anemia are not a particular health hazard if they are treated immediately. Delaying treatment of pernicious anemia can cause permanent damage to the spinal cord with permanent walking difficulties, balance disorders, and possibly mental disorders requiring psychiatric treatment.

What to do?

If you have any of the symptoms described, contact your doctor. If your movement, balance or memory is disturbed, immediately go to your doctor. If you have a relative who is suffering from pernicious anemia, tell the doctor. Blood tests may exclude the possibility of one of the two main types of anemia, but the exact diagnosis can only be set on the basis of other examinations at the hospital. This includes bone marrow biopsies, additional blood tests, and perhaps digestion of the digestive tract. In addition, you may also go to a special search called the Schilling test. It involves taking vitamin B12 and measuring the amount of urine collected in 24 hours.


As soon as the vitamin B12 absorption capacity is lost through the digestive tract, it may never be rejuvenated, so treatment of anemia due to lack of vitamin B12 consists of lifelong vitamin injections. These injections are usually given in the ambulance. You will probably get one injection per week in the first month. Small wounds on the mouth, loss of memory and depression may disappear after the first injection. It may even take several months for walking and balance problems to go away, though it may happen that these problems never disappear if they last for a long time before the start of the treatment.

After a few weeks, the number of injections is reduced to one per month. It’s vital that you do not miss the treatment because your symptoms will almost certainly come back.

Anemia due to lack of folic acid caused by poor diet can be completely lost if it is first treated with folic acid tablets, and after that with food containing sufficient amounts of this vitamin. In cases of insufficient vitamin deficiency due to insufficient abundance of absorption, additional folic acid tablets may need to be taken until the basic cause of the abnormal absorption goes away.