Pernicious anemia. Malignant anemia Pernicious anemia and stomach cancer

Endogenous B12 vitamin deficiency caused by atrophy of the glands of the fundus of the stomach that produce gastromucoprotein. This leads to impaired absorption of vitamin B12, necessary for normal hematopoiesis, and the development of pathological megaloblastic hematopoiesis, resulting in “pernicious” type anemia. People over the age of 50 get sick.

Symptoms of pernicious anemia

Characterized by disorders of the cardiovascular, nervous, digestive and hematopoietic systems.

Patients' complaints are varied:

• general weakness,
• dyspnea,
• heartbeat,
• pain in the heart area,
• swelling of the legs,
• crawling sensation in the hands and feet,
• gait disorder,
• burning pain in the tongue,
• periodic diarrhea.

The patient's appearance is characterized by pale skin with a lemon-yellow tint. The sclera is subicteric. The patients are not exhausted. When researching of cardio-vascular system Anemic sounds associated with decreased blood viscosity and increased blood flow are typical.

On the part of the digestive organs, the so-called Gunter's glossitis is detected (the tongue is bright red, the papillae are smoothed), histamine-resistant achylia (lack of free of hydrochloric acid and pepsin in gastric contents). The liver and spleen are enlarged.

With a significant decrease in the number of red blood cells (below 2 million), fever is observed wrong type. Changes nervous system associated with degeneration and sclerosis of the posterior and lateral columns spinal cord(funicular myelosis).

Blood picture:

• hyperchromic type anemia,
• macrocytes,
• megalocytes,
• red blood cells with Jolly bodies,
• Cabot's rings,
• leukopenia,
• thrombocytopenia (during exacerbation).

Descriptions of symptoms of pernicious anemia

Which doctors should I consult for pernicious anemia?

Treatment of pernicious anemia

Treatment is carried out with vitamin B12-100-200 mcg intramuscularly daily or every other day until remission occurs. If an anemic coma occurs, urgent hospitalization, blood transfusion, preferably red blood cells (150-200 ml). Maintenance therapy with vitamin B12 is necessary to prevent relapses.

Systematic monitoring of blood composition in people with persistent achylia, as well as those who have undergone gastrectomy, is indicated. Patients suffering from pernicious anemia should be under medical supervision (stomach cancer may occur).

Health

Pernicious anemia is a condition in which the affected person's body is no longer able to produce the required amount of healthy red blood cells due to a deficiency of vitamin B12 ( nutrient contained in certain foods).

For example, people who suffer from pernicious anemia are unable to absorb enough vitamin B12 due to a lack of something called intrinsic factor (a protein produced in the stomach).

However, other causes and conditions can lead to vitamin B12 deficiency.

Causes of pernicious anemia and risk factors

-- One of the most common causes is a lack of gastric intrinsic factor, which causes the human body to be unable to absorb enough vitamin B12.

-- Some cases of pernicious anemia occur due to the presence of harmful bacteria in the small intestine, which in turn causes the small intestine to not properly absorb vitamin B12; interfere with the absorption of vitamin B12 and certain diseases, taking certain medications, surgical intervention by partial or complete removal small intestine, as well as taeniasis (the presence of worms of a certain group).

-- Another reason why the human body may not receive adequate amounts of vitamin B12, resulting in pernicious anemia, is a deficiency of this vitamin in the patient's diet.

There are also several risk factors which increase the likelihood of pernicious anemia:

-- Having a family history of the condition (family history).

-- If there was an operation to partially or completely remove the stomach.

-- If you have certain autoimmune diseases that affect the endocrine glands (for example, chronic failure adrenal cortex (Addison's disease), group 1 diabetes, Graves' disease and vitiligo).

-- If there was surgery to partially or completely remove the small intestine.

-- If there are certain gastrointestinal diseases or disorders that prevent the patient's body from properly absorbing vitamin B12.

-- If certain medical supplies, one of side effects which also lies in the fact that the body temporarily ceases to properly absorb vitamin B12.

-- If the patient adheres to a strict vegetarian diet, not allowing himself a single gram of meat and dairy products and refusing to take vitamin B12 supplements. Very often, poor nutrition in general is a risk factor.

Symptoms and treatment of pernicious anemia

In addition to the symptoms characteristic of all types of anemia (fatigue, dizziness, etc.), vitamin B12 deficiency is accompanied by characteristic serious symptoms:

-- Nerve damage.

-- Neurological problems, such as confusion, dementia, depression and memory loss.

-- Symptoms related to the gastrointestinal tract and include nausea and vomiting, heartburn, bloating and gas, constipation or diarrhea, loss of appetite and weight loss.

-- Enlarged liver.

-- Swelling of the tongue, which loses its roughness and becomes smooth.

-- Children infancy Those who suffer from vitamin B12 deficiency may exhibit poor reflexes, inappropriate body movements, and twitching of the facial muscles.

Measures to treat pernicious anemia usually include replacing the vitamin B12 the body does not receive.

Treatment can be characterized by very successful results, but it requires a long period of time and sometimes lasts throughout the patient’s life.

Pernicious anemia has general symptoms with other types of anemia, but the diagnosis is based on very precise clinical data. Let's consider the features and methods of treatment of this type of anemia.

Features of pernicious anemia

Pernicious anemia is a progressive disease, i.e. it gradually intensifies. Associated with deficiency of a specific vitamin B12 or cobalamin, important for the formation and maturation of red blood cells in the blood.

In addition, the accelerated destruction of red blood cells provokes increased bilirubin levels, a substance that is formed as a result of the catabolism of hemoglobin.

Pernicious anemia is quite common in old age, due to reduced functionality gastrointestinal tract, which loses the ability to effectively absorb many vitamins, including B12.

More rarely, megaloblastic anemia affects children, in which, as we will see later, it is most often associated with genetic reasons or eating disorders.

Symptoms of megaloblastic anemia

The symptoms of pernicious anemia are caused by low efficiency in transporting oxygen to the tissues and are therefore common to all other types of anemia.

In particular:

• pallor associated with reduced blood flow to the skin
• fatigue and apathy caused by muscle hypoxia
• tachycardia, due to the heart's attempt to compensate for the reduction in oxygen flow
• dizziness, confusion and memory loss, due to the fact that vitamin B12 is a cofactor important for the functioning of nerve cells, and the deficiency of which leads to neurological changes.

How is pernicious anemia diagnosed?

A diagnostic test for pernicious anemia includes, first of all, a complete blood count, which confirms the diagnosis if:

• red blood cell count less than 3 million per mm3
• there is a decrease in the level serum iron
• test for vitamin B12 below control values ​​– 200 - 900 pg/ml
• Ferritin level is reduced, i.e. iron reserves
• the average volume of erythrocytes is increased, since unripe erythrocytes are large

Other tests used for the diagnosis of pernicious anemia:

• indirect bilirubin level, which increases in pernicious anemia
• gastrin level, is a hormone that is present in the gastric mucosa and is necessary for the absorption of vitamin B12
• alkaline phosphatase level, which allows you to evaluate the activity of white blood cells to identify autoimmune causes of the disease

Decreased levels of red blood cells and iron have a negative prognosis if not corrected, as they can lead to significant complications, especially when the nervous system is stressed: cobalamin deficiency over a long period of time can lead to irreversible nerve damage.

Causes of pernicious anemia

Typically, vitamin B12, present in animal products, binds to the Castle factor, which is secreted by the gastric mucosa and has the task of promoting the absorption of cobalamin in the intestines.

Thus, vitamin B12 deficiency may result from:

• insufficient consumption of animal foods (vegetarian diet): Vitamin B12 occurs naturally only in animal products, so a vegetarian diet (without the use of supplements) inevitably leads to vitamin B12 deficiency.
• Intrinsic factor deficiency caused by damage to the gastric mucosa. Damage to the gastric walls can be caused by stomach cancer, alcohol, infection of the stomach by helycobacter bacteria, or Birmer's disease ( autoimmune disease, in which antibodies attack and destroy the stomach’s own mucosa, causing it to atrophy).
• Malabsorption in the intestine, as in the case of Crohn's disease, in which intestinal cells lose the ability to absorb vitamin B12.
• Congenital intrinsic factor deficiency, a rare genetic pathology in which the synthesis of Castle factor is disrupted. The disease is present from birth and manifests itself in children up to the age of five.

Therapy for macrocytic anemia: nutritional supplements and diets

In the case of pernicious anemia, therapy consists of administering to the patient:

• vitamin B12 tablets to compensate for its deficiency;
• gland to restore the level of this mineral in the blood;
• folic acid , which stimulates the synthesis and production of red blood cells.

In case of malabsorption of vitamin B12 or gastric atrophy, vitamin B12 is administered by injection or nasal spray.

Important role in the prevention and treatment of pernicious anemia food plays. Cobalamin can be found in foods such as:

• liver
• egg yolk

and to a lesser extent in:

• mature cheeses
• spirulina algae

Diverse and balanced diet provides food required quantity vitamin B12, But vegetarian diets, and especially vegan ones, require appropriate integration of this important vitamin so as not to risk and not face the consequences of pernicious anemia.

Vitamins play a huge role for humans; if you do not receive enough vitamin B12, B12-deficiency anemia (pernicious anemia) develops. This name comes from the Latin word perniciosus, that is, disastrous, dangerous. The disease is also called Addison-Biermer disease, and was once called malignant anemia. The description of this disease in the second half of the 19th century was carried out by doctors Thomas Addison and Anton Birmer, in honor of which their surnames were included in the name of the disease. As a result of the pathology, the process of hematopoiesis is disrupted, and the bone marrow and nervous system suffer greatly from this. If this type of anemia is not treated, the person becomes paralyzed, he loses vision, smell, hearing, etc.

Vitamin B12 enters the human body with food - from meat, some vegetables and dairy products. When food is digested in the stomach, it must contact a protein substance, intrinsic factor Castle, which is produced by the cells of the stomach. Only in this case can vitamin B12 be absorbed into ileum. Otherwise, it will be eliminated from the body with feces. It is known that the liver contains a large reserve of this vitamin, therefore pathological changes And severe symptoms B12-deficiency anemia appears only 2-3 years after the onset of the disease.

Pernicious anemia can develop for a number of reasons. Among them:

Risk factors for developing pernicious anemia include elderly age and various stomach diseases.

Symptoms of pernicious anemia

At the very beginning, the symptoms are subtle, but over the years they confidently assert themselves. At first, a person feels weakness, fatigue, dizziness, and rapid heartbeat and shortness of breath on exertion. Many people attribute this to age or manifestations of others chronic diseases.

But when Addison's disease has already taken hold, yellowness of the sclera of the eyes appears, general pallor of the skin with a clear yellow tint. Quite often the tongue becomes inflamed - glossitis develops, accompanied by pain when swallowing and at rest. The tongue itself acquires a bright red color, its texture is smoothed out, and it becomes, as it were, “polished.” Often, problems in the oral cavity are accompanied by stomatitis.

With Addison-Biermer anemia, the nervous system is damaged - funicular myelosis is observed. Among the first signs are constant painful sensations in the arms and legs - numbness, tingling and a feeling of “pins and needles”. Patients with this disease notice increasing muscle weakness, which can develop into gait disturbances and muscle atrophy. Gradually, disorders affect the rectum and bladder– fecal and urinary incontinence and impotence in men develop.

Without treatment, the damage spreads to the spinal cord. As a result, problems with the legs begin, disturbances in the superficial and deep sensitivity of the tissues. Subsequently, the symptoms rise, affecting the abdomen, chest, etc. A person loses vibration sensitivity, partially hearing and smell. Sometimes mental disorders occur, accompanied by visual and auditory hallucinations, memory impairment and delirium.

Along with damage to the spinal cord, peripheral nerves are affected. Patients have decreased vision, develop weakness and drowsiness, depression and apathy, tinnitus, headaches and dizziness. In severe cases of the disease, depression of reflexes and paralysis of the lower extremities are noted.

Diagnostic measures

A simple blood test is enough to diagnose vitamin B12 deficiency. Examination of a blood sample under a microscope reveals the presence of megaloblasts - overly large red blood cells. Along with this, a person suffering for a long time pernicious anemia, altered platelets and white blood cells may be present.

If vitamin B12 deficiency is confirmed, then an analysis is done to determine its content in the blood, and then other studies to identify the cause of the pathology. They begin with blood tests for the presence of antibodies - immunoglobulins to the internal factor of Castle. These substances are present in 60-85% of patients with pernicious anemia.

Then the function of gastric secretion is examined. A thin tube is inserted through the patient's nose into the stomach cavity. A hormone is then injected into a vein to stimulate the production of intrinsic factor. After some time, a fluid sample is aspirated from the stomach to determine intrinsic factor levels.

If previous tests have not given a clear picture, the doctor may refer the patient to a Schilling test. It determines how well orally administered vitamin B12 is self-absorbed in the small intestine. The analysis is repeated with the introduction of the internal factor. The diagnosis of pernicious anemia is confirmed if vitamin B12 is absorbed only with the introduced intrinsic factor, and not without it. Among other things, infestations by wide and flat tapeworm are excluded, and an X-ray examination or gastroscopy is performed to check for the absence of stomach cancer.

Treatment of pathology

The treatment regimen for Addison-Biermer anemia is chosen based on the cause of the disease, the severity of symptoms and the presence of nervous system disorders.

If the patient is diagnosed with worms, deworming is carried out with fenasal or male fern extract.

For diarrhea and intestinal diseases, calcium carbonate and Dermatol are prescribed, as well as enzymatic agents - Festal, Panzin and Pancreatin. To normalize intestinal flora, take the mentioned enzyme agents in combination with a diet aimed at eliminating fermentative or putrefactive dyspepsia.

All patients with folic acid and vitamin B12 deficiency are advised to abstain from drinking alcohol. The diet should be balanced and contain the proper amount of vitamins and protein. Beef (especially liver and tongue), rabbit meat, eggs, seafood (mackerel, cod, octopus, sea bass, etc.), legumes and fermented milk products are very healthy. Fatty foods should be limited, as fats slow down the process of hematopoiesis in the bone marrow.

For autoimmune causes of the disease, patients are given injections of vitamin B12, and antibodies to the intrinsic factor of Castle are neutralized with the help of prednisolone. In severe cases, when there is a strong decrease in hemoglobin (less than 70 g/l) and the appearance of symptoms of a coma, red blood cells are administered.

Synthetic vitamin B12 (oxycobalomin or cyanocobalamin) is administered intramuscularly daily for 2-3 days, and then after blood tests confirming replenishment of reserves, injections are given every other day or according to the schedule recommended by the doctor. Oral intake of this vitamin is prescribed when there is insufficient dietary intake, for example, in strict vegetarians.

Therapy for B12-deficiency anemia is based on the following principles - saturate the body with cyanocobalamin, carry out maintenance injections and prevent further development anemia. Most often, treatment begins with the administration of 500 micrograms of cyanocobalamin 1-2 times a day. If the patient experiences complications, the dose is doubled. After 10 days of therapy, the dosage is reduced. Treatment continues for another 10 days, and then for six months injections are given once every 2 weeks. During this time, all neurological abnormalities should disappear. Maintenance therapy can continue for life. After six months of treatment, patients sometimes experience Iron-deficiency anemia, so they are prescribed a short course of oral iron supplements.

With Addison-Biermer anemia, destructive changes in the body occur unnoticed. It is very dangerous to leave the disease to chance, as the consequences can lead to disability or death. Depending on the cause of anemia, the disease is completely cured or successfully stopped.

Pernicious anemia is a disease that begins to manifest itself years after its onset. During this time, the human body experiences irreversible changes from the gastrointestinal tract, nervous system and bone marrow. This leads to the development of many symptoms and their complications. This is why this type of anemia needs to be diagnosed and treated as early as possible. Knowing the first symptoms and causes of the disease can help prevent complications.

Pernicious anemia (B12 deficiency, megaloblastic or Addison-Biermer disease) is a disease of the blood system characterized by a decrease in hemoglobin and the number of red blood cells, resulting from a lack of vitamin B12 (cyanocobalamin) and affecting the digestive, nervous and hematopoietic systems.

What happens with pernicious anemia?

Normally, vitamin B12 is absorbed in the stomach when it is separated from proteins supplied with food (meat, fermented milk products). Enzymes are required for this breakdown gastric juice and specific internal factor Castle, which also serves as a carrier protein for vitamin B12. Only in the presence of this factor is the vitamin absorbed into the bloodstream; in its absence, cyanocobalamin enters colon and is excreted from the body along with feces.

Vitamin deficiency does not manifest itself clinically immediately, since it is synthesized in the liver and for some time (about 2 - 4 years) compensation for hypovitaminosis occurs. Castle factor is produced by specific parietal cells of the gastric mucosa; when they are damaged or destroyed, the risk of pernicious anemia increases.

Possible causes of pernicious anemia

How does pernicious anemia manifest?

Pernicious anemia is a polysyndromic disease, that is, it manifests itself in many symptoms. Vitamin B12 is involved in the formation of blood cells, metabolic processes occurring in the nervous system. Therefore, a deficiency of this vitamin is primarily manifested by symptoms in the blood system, gastrointestinal tract and nervous system.

1. Anemic syndrome. With a lack of cyanocobalamin, the formation of normal red blood cells is disrupted, they stop carrying oxygen to tissues and organs. This causes weakness, pallor skin, fast fatiguability, tachycardia (increased heart rate), shortness of breath and dizziness. Sometimes a low-grade fever may occur - an increase in body temperature to low numbers (not higher than 38 degrees).
2. Gastroenterological syndrome - manifestations from the organs digestive system. There is a decrease in appetite, stool disturbances (constipation or diarrhea), and an increase in liver size (hepatomegaly). Characteristic changes in the language. They appear in the form inflammatory reactions mucous membrane of the tongue (glossitis) or corners of the lips (angulitis), in the form of burning and pain in language. Also specific symptom there will be a “varnished tongue” - this is a smooth crimson tongue. In the stomach, atrophy of the mucous membrane and the development of atrophic gastritis with a decrease in secretory functions will occur.
3. Neurological syndrome is a manifestation of the nervous system. They arise as a result of disturbances in fat metabolism and the formation of toxic acids that damage nerve cells. There is also a disruption in the synthesis of myelin, which is necessary for the formation of the protective sheath of the nerves. The syndrome manifests itself in the form of numbness of the limbs, gait disturbances and fine motor skills, muscle stiffness. Also, as a result of relaxation of the sphincters, enuresis (urinary incontinence) and encopresis (fecal incontinence) can occur. Mental symptoms such as insomnia, depression, psychosis or hallucinations may occur.
4. Hematological syndrome - blood symptoms. It appears in the results of a blood test in the form of progressive anemia (decrease in hemoglobin and red blood cells), leukopenia (decrease in the number of white blood cells), and the appearance of atypical red blood cells - megaloblastic forms.