Pernicious Anemia and Vitamin B-12 Deficiency

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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Anemia is a condition in which the body does not have a sufficient number of red blood cells or hemoglobin. Hemoglobin is present within red blood cells and is important for carrying oxygen to all tissues of the body. In males, anemia is typically defined as hemoglobin level of less than 13.5 gram/100ml, while in women, a hemoglobin level of less than 12.0 gram/100ml is considered to be indicative of anemia. These definitions may vary slightly depending on the source and the laboratory reference used. Pernicious is a term that means destructive, injurious or deadly.

Pernicious anemia is a disease where large, immature, nucleated cells (megaloblasts, which are forerunners of red blood cells) circulate in the blood, and do not function as blood cells; it is a disease caused by impaired uptake of vitamin B-12 due to the lack of intrinsic factor (IF) in the gastric mucosa. It was termed "pernicious" because before it was learned that vitamin B-12 could treat the anemia, most people that developed the disease died from it.

Anemia can result from disruptions in the production of red blood cells or hemoglobin as well as from an increased destruction of red blood cells or loss of blood.

Pernicious anemia is due to an inability to absorb vitamin B-12 (also known as cobalamin or Cbl) from the gastrointestinal tract. Humans get vitamin B-12 from animal products; both meat and dairy products are dietary sources of vitamin B-12. The body is able to store vitamin B-12 for a long time, so inadequate dietary intake must persist for years before a true deficiency of vitamin B-12 is reached. Because of this, the symptoms of pernicious anemia usually do not appear for years. While pernicious anemia is most commonly diagnosed in adults with an average age of 60, a rare, congenital (inborn) type of pernicious anemia has been described.

As with other causes of anemia, symptoms related to decreased oxygen-carrying capacity of the blood can include tiredness and shortness of breath. Vitamin B-12 deficiency also interferes with the function of the nervous system, and symptoms due to nervous system damage may be apparent even before the anemia is discovered.

Pernicious anemia is most common in Caucasian persons of northern European ancestry than in other racial groups. In this population, 10-20 people per 100,000 persons are diagnosed each year with pernicious anemia. Pernicious anemia is also termed Biermer's or Addison's anemia.