Greetings, Dr. Roach In October 2024, I was diagnosed with pernicious anemia at the age of 71. I had inadequate levels of folate and B12. While my intrinsic factor antibodies were negative, my antiparietal antibodies were aberrant. After six days of daily B12 injections, I currently only get them once a month. I take folate every day as well.
I’m still breathless and quite exhausted. I still feel tingling in my hands and feet, but my mental fog has significantly improved. Some members of the support group I’m a part of take B12 injections every other day, but I can’t find any evidence that this is the norm. Could you tell me more about pernicious anemia and how it’s treated? — M.P.
ANSWER: In pernicious anemia (PA), an inflammatory condition, the stomach’s cells that produce intrinsic factor (IF), a glycoprotein essential for effective B12 absorption, are destroyed by the body.
In the absence of IF, the body must obtain B12 via injection or extremely high oral B12 dosages. In addition to anemia, the body may experience neurological and mental problems if B12 is not present. Anemia frequently manifests as fatigue and dyspnea.
Before the discovery of vitamin B12, the term “pernicious” was used. Although liver and liver extract—both of which contain high levels of vitamin B12—were administered, there was no particular treatment.
Pernicious anemia can be diagnosed using IF antibodies, however only roughly 70% of PA patients will have them. Anti-parietal antibodies do not establish the diagnosis on their own because they can be detected in illnesses other than PA. However, the diagnosis of B12 deficiency becomes quite plausible in a person with low B12 levels and the kind of anemia known as megaloblastic anemia with atypical white blood cells and very large red cells. This is especially true when symptoms improve with treatment.
On the other hand, anemia caused by a lack of folate is identical to anemia caused by a lack of B12. Given your low levels of both folate and B12, it makes sense to address your condition by replacing both nutrients.
High-dose oral B12 or injection B12 are both viable choices for treating PA in patients with no alarming symptoms. To prevent potentially irreversible nerve damage, individuals with severe anemia or neuropsychiatric symptoms (such as the tingling and fogginess you mentioned) should receive prompt medical attention.
This often entails weekly injectable treatments for a week, followed by monthly injection B12 therapies for at least a month. Monthly B12 injections or daily high-dose oral B12 may also be used to treat a patient once their symptoms have subsided.
These are merely recommendations. There is relatively little risk in administering B12, and some people may benefit from more rigorous treatment. However, I can promise you that your symptoms are likely to continue to improve; regrettably, complete recovery is not guaranteed. It’s encouraging that you are still getting better.
More advice
-
Miss Manners: How do I get my future in-laws to let me help pay for my son s wedding without insulting them?
-
Dear Abby: I looked to my co-worker for emotional support, but he left me in the dust to advance himself
-
Asking Eric: Writer wants to change belittling patterns they learned as a child
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
(c) Syndicate Inc., 2022 North America.
All rights reserved.
