B12-scarce anemia

Description:

Pernicious anemia  (Latin perniciosus - disastrous, dangerous) or B12 - scarce anemia or megaloblastny anemia or Addison-Birmera's disease or (the outdated name) a malignant anemia - the disease caused by disturbance of a hemopoiesis because of a lack of a B12 vitamin organism. Marrow and fabrics of a nervous system are especially sensitive to deficit of this vitamin.

In 1855 the English doctor Thomas Addison, and then in 1872 in more detail the German doctor Anton Birmer described a disease which was called malignant (pernicious) anemia. Soon the French doctor Armand Trousso suggested to call these diseases addisonovy anemia and Addison's disease.

In 1926 J. Whipple, J. Minot and U. Murphy reported that pernicious anemia is treated by introduction to a food allowance of a crude liver and that inborn inability of a stomach to cosecrete the substance necessary for absorption of B12 vitamin in intestines is the cornerstone of a disease. For this opening they in 1934 got the Nobel Prize.

Megaloblastny anemias - groups of the diseases which are characterized by weakening of synthesis of DNA therefore division of all fast-proliferating cells (hemopoietic cells, cells of skin, cells of a GIT, mucous membranes) is broken. The hemopoietic cells belong to the most quickly breeding elements therefore anemia, and also quite often a neutropenia and thrombocytopenia come to the forefront in clinic. Deficit of cyanocobalamin or folic acid is the main reason for megaloblastny anemia.

Symptoms of B12-scarce anemia:

B12-scarce anemia develops rather slowly and can be oligosymptomatic. Clinical signs of anemia are not specific: weakness, bystry fatigue, asthma, dizziness, heartbeat. Patients are pale, subikterichna. There are glossitis signs - with sites of an inflammation and atrophy of nipples, the varnished language, can be increase in a spleen and liver. Gastric secretion sharply decrease. At the fibrogastroscopy the stomach mucosal atrophy which is confirmed and histologically comes to light. Also symptoms of defeat of a nervous system (a funicular myelosis) which not always correlate with an anemia vyrzhennost are observed. In the osnoyena of neurologic manifestations demyelination of nerve fibrils lies. It is noted distal paresthesias, a peripheral polyneuropathy, disorders of sensitivity, increase in tendon jerks.

Thus the triad is characteristic of B12-scarce anemia:
- blood defeat;
- damage of a GIT;
- defeat of a nervous system.

Reasons of B12-scarce anemia:

Various etiological factors can cause deficit of cyanocobalamin or folic acid (is more rare the combined insufficiency than both) and development of megaloblastny anemia.

The following reasons can cause deficit of cyanocobalamin:
- low contents in a diet;
- vegetarianism;
- low absorption;
- deficit of an internal factor;
- pernicious anemia;
- gastrectomy;
- stomach epithelium poverzhdeniye chemical substances;
- infiltrative changes of a stomach; (lymphoma or carcinoma);
- disease Krone;
- Gee's disease;
- ileectomy;
- atrophic processes in a stomach and a gut;
- the increased B12 vitamin utilization by bacteria with their excess growth;
- a state after an applying gastrointestinal anastomosis;
- jejunum diverticulums;
- intestinal стаз or the obstruction caused by strictures;
- helminthic invasion;
- tape-worm wide (Diphyllobotrium latum);
- pathology of the absorbing site;
- tuberculosis of an ileal gut;
- lymphoma of a small bowel;
- to a spr;
- regional enteritis;
- other reasons.
- inborn lack of transcobalamine 2 (rarely)
- abuse of nitrous oxide (inactivates B12 vitamin oxidizing cobalt);
- the absorption disturbance caused by use of Neomycinum, colchicine.

Can be the reasons of deficit of folates:
1. Insufficient receipt
- scanty diet;
- alcoholism;
- psychological anorexia;
- parenteral food;
- unbalanced food at elderly.

2. Absorption disturbance
- malabsorption
- changes of a mucous membrane of intestines
- Gee's disease and to a spr
- disease Krone
- regional ileitis
- intestines lymphoma
- reduction of a reabsorbiruyushchy surface after a jejunum resection
- reception of antikonvulsant

3. Increase in requirement
- pregnancy
- hemolitic anemia
- exfoliative dermatitis and psoriasis

4. Utilization disturbance
- alcoholism;
- antagonists of folates: Trimethoprimum and methotrexate;
- inborn disturbances of metabolism of folates.

Treatment of B12-scarce anemia:

Complex medical an action at B12 - scarce anemia should carry out taking into account an etiology, expressiveness of anemia and existence of neurologic disturbances. At treatment it is necessary to be guided by the following provisions:
- an indispensable condition of treatment of B12 - scarce anemia at a helminthic invasion is deworming (for exile of a wide tape-worm appoint phenasal according to a certain scheme or extract of a men's fern).
- at organic diseases of intestines and ponosa it is necessary to use fermental drugs (панзинорм, festal, Pancreatinum), and also the fixing means (calcium carbonate in combination with Dermatolum).
- normalization of an indestinal flora is reached by reception of fermental drugs (панзинорм, festal, Pancreatinum), and also selection of the diet promoting elimination of syndromes of putrefactive or fermentative dyspepsia.
- the balanced food with the sufficient content of vitamins, protein, unconditional prohibition of alcohol - an indispensable condition of treatment of B12 and foliyevodefitsitny anemia.
- pathogenetic therapy is performed by means of parenteral administration of B12 vitamin (cyanocobalamin), and also normalization of the changed indicators of the central hemodynamics and neutralization of antibodies to gastromucoprotein ("internal factor") or a complex gastromucoprotein + B12 vitamin (corticosteroid therapy).

Hemotransfusions carry out only at considerable decrease in hemoglobin and manifestation of symptoms of coma. It is recommended to enter eritrotsitny weight on 250 - 300 ml (5 - 6 transfusions).

Prednisolonum (20 - 30 mg/days) is recommended at the autoimmune nature of a disease.

Principles of therapy:
- to saturate an organism with vitamin
- maintenance therapy
- prevention of possible development of anemia

Use cyanocobalamin in doses of 200-300 micrograms (scales) more often. This dose is applied if there are no complications (a funicular myelosis, a coma). Now apply 500 micrograms daily. Enter 1-2 times a day. In the presence of complications of 1000 micrograms. In 10 days the dose decreases. Injections proceed 10 days. Then, within 3 months weekly enter 300 micrograms. After that, within 6 months 1 injection in 2 weeks becomes.