PERNICIOUS ANAEMIA

Dr DEEPAN P SHAH (MD)

Pernicious Anaemia is caused due to deficiency of Vitamin B12.

Pernicious literally means deadly, if untreated patient may develop irreversible pathological changes also stomach cancer in many untreated long haulers. Untill adevent of Vitamin B12 treatment it was considered untreatable and fatal but now with proper regular vitamin B12 supplimentation it is easily treated.

CAUSES OF PERNICIOUS ANAEMIA

Pernicious Anaemia is a later stage complication of Vitamin B12 deficiency.

Vitamin B12 deficiency may be due to

  1. Dietary insufficiency of Vitamin B12
  2. Lack of Gastric Intrinsic Factor(GIF) due to various pathological factors that may damage Gastric Parietal Cells which produces Gastric Intrinsic Factor eg autoimmunity etc.
  3. Other reasons like partial or complete gastrectomy.
  4. Lack of Hepatocorin due to corresponding gene defect.

PATHOPHYSIOLOGY OF PERNICIOUS ANAEMIA

Transportation and Absorption of Vitamin B12

TCN1 gene on chromosome 11 is responsible for production of transcobalamine-1 also called as Heptacorrin which is a glycoprotein secreted by salivary glands binds with VitaminB12 to form Heptacorrin-VitaminB12 complex thus helping transport of acid-sensitive vitamin B12 safely through the acidic medium of stomach into the deudenum region of small intestine.

In deudenum, the proteases from pancreatic enzymes degrade and detach this glycoprotein carrier heptacorrin from Vitamin B12.

Vitamin B12 in then gets attached to Gastric Intrinsic Factor also called Intrinsic Factor. GIF gene on chromosome 11 is responsible for production of Gastric Intrinsic Factor which is a glycoprotein secreted by parietal cells of stomach.

After attaching to Gastric Intrinc Factor this GIF-VitaminB12 complex is then transported and absorbed by Enterocytes in ileum region of small intestine.

In ileum, the Gastric intrinsic factor is detached and degraded from this GIF-VitaminB12 and Vitamin B12 is relaeased. Vitamin B12 is then taken up by Transcobalamine-2 (TCN2) which is then transported to tissues.

Biochemical Role Of Vitamin B12

Vitamin B12 is required to synthesis 5-Methyltetrahydrofolate and Homocysteine in presence of vitamin B12 and Methionine synthase produces Tetrahydrofolate and Methionine – Due to deficiency of vitamin B12 there is depletion in this process, which causes accumulation of 5-Methyltetrahydrofolate consequently reducing formation of various other folate products required for Thymidylate and Purine affecting DNA synthesis and replication thus hampering maturation erythrocytes (Red Blood Cell) resulting into immature, large and fragile Red blood Cells a picture of Megaloblastic Anaemia a feature of Pernicious Anaemia.

SYMPTOMS OF PERNICIOUS ANAEMIA

As described earlier Pernicious Anaemia is a later stage complication of vitamin B12 deficiency. So the patients of pernicious anaemia shows symptoms of Vitamin B12 deficiency along with general symptoms of anaemia. Typically complicating each other and showing involvement of neurological, Psychological, Gastric, Cardiac, aspects as well.

  • Weakness, lethargy, general debility, malaise, weight loss.
  • impaired growth in children delayed puberty Palor, pale face, mucousa and conjunctiva.
  • Tingling numbness of limbs, altered proprioception, altered gait, muscle weakness, clumsiness, myalgia paraesthsia lower extremities,
  • Subacute combined spinal cord degeneration leading to loss of ankle relfex and increased knee and extensor plantar response.
  • Impaired Urination
  • Brain fog, lack of concentration, lack of alertness, weakness of memory, weak cognition, cant comprehend easily, sluggish response, somnolence, disturbed sleep pattern, anger, irritability, mood swings, depression, psychosis.
  • Gastritis, Hyperacidity, Gastro-Esophageal Reflux Disorder (GERD), Diarrhoea, Jaundice, Ulcerative Stomatitis, Angular Cheilitis.
  • Tachycardia, cardiac murmurs, altered blood pressure, easily gets exhausted on exertion, Dyspnoea on Exertion.
  • Pancytopenia, hemolysis, pseudo-thrombotic micro-angiopathy.
  • Thyroid disorders

DIAGNOSIS OF PERNICIOUS ANAEMIA

Blood teat for Vitamin b12 level and Complete Blood Count (CBC)report is required.

Low Vitamin B12 level and low Heamoglobim parameters pancytopenia with a picture of Megaloblastic Anaemia are suggestive criteria for diagnosis of pernicious anaemia.

HOMEOPATHIC TREATMENT OF PERNICIOUS ANAEMIA

Homeopathic treatment of pernicious anaemia depends upon presenting symptoms which systems are involved and the severity of the condition. it is also important to evaluate whether vitamin B12 deficiency is due to insufficient dietary intake or is secondary to some other pathological condition in body like autoimmune disorders etc. and accordingly the patient should be treated

Supplimenting with Vitamin B12 and increasing food rich in vitamin B12 should be first priority in all the cases to bring back vitamin B12 levels back to normal AS SOON AS POSSIBLE to prevent further damage.

HOMEOPATHIC MEDICINES FOR PERNICIOUS ANAEMIA

Constitutional remedy selection and treatment is recomended for all those who have vitamin B12 deficiency secondary to some other disease condition and not primarily due to imsufficient dietary intake of Vitamin B12.

Few of the Homeopathic remedies which may prove useful varing and depending on cases to case in treatment of pernicious anaemia are listed below

  • KALIUM PHOSPHORICUM
  • NATRUM PHOSPHORICUM
  • CINCHONNA OFFICINALIS
  • FERRUM METALLICUM
  • FERRUM PHOSPHORICUM
  • GELSEMIUM SEMPERVIRENS
  • ARSENICUM ALBUM
  • NATRUM MURIATICUM
  • ABROTANUM
  • ALFALFA
  • LYCOPODIUM
  • CHELIDONIUM MAJUS
  • CARDUS MARIANUS
  • MEDHORRINUM
  • RHUS TOXICODENDRON
  • ARNICA MONTANA

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