Pernicious Anemia and Vitamin B-12 Deficiency

  • Medical Author:
    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.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    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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What kinds of doctors treat pernicious anemia?

Pernicious anemia may be treated by internal or family medicine specialists as well as specialists in disorders of the blood (hematologists).

How is pernicious anemia/vitamin B-12 deficiency diagnosed?

The first step is always a thorough history and physical examination by a health care practitioner. The results of this examination are used to help direct further testing. A number of laboratory tests are available that can help diagnose pernicious anemia as well as other causes of vitamin B-12 deficiency. These tests include:

  • A complete blood cell count (CBC)
  • Examination of a blood smear (peripheral smear) under a microscope, often performed in association with a CBC
  • Blood vitamin B-12 level measurements
  • Tests for the presence of autoantibodies to intrinsic factor or stomach lining cells
  • Blood levels of iron and iron-binding capacity
  • Folate levels (which are often reduced when vitamin B-12 levels are low)
  • Blood levels of methylmalonic acid or homocysteine, both of which may be sensitive indicators of vitamin B-12 deficiency
  • The Schilling test, a measure of how well the body can absorb vitamin B-12, is less commonly used today than in the past.
  • Finally, bone marrow aspiration or bone marrow biopsy may be recommended in some cases if bone marrow disorders are suspected

What is the treatment for pernicious anemia and vitamin B-12 deficiency?

The symptoms of pernicious anemia and vitamin B-12 deficiency can be treated by replenishing the vitamin B-12 supply in the body. If a condition other than pernicious anemia is responsible for vitamin B-12 deficiency, treatment also must be directed at the underlying condition. Symptoms of vitamin B-12 deficiency may be improved after just a few days of medical treatment.

Vitamin B-12 is typically given as an intramuscular injection (shot). An injection of 1000 micrograms (1 mg) of vitamin B-12 is generally given every day for one week, followed by 1 mg every week for four weeks and then 1 mg every month thereafter.

Alternative treatments for pernicious anemia include high-dose oral vitamin B-12, since a lower-efficiency absorption system for vitamin B-12 exists in the intestine that does not require the presence of IF. However, the oral dose required for this type of therapy (1 to 2 milligrams/day) is more than 200 times higher than the minimum daily vitamin B-12 requirement for adults and is significantly higher than that available in most standard multivitamins and B-12 supplements. Nasal spray and sublingual (under the tongue) preparations of vitamin B-12 also are available and are under investigation.

Medically Reviewed by a Doctor on 5/11/2016

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