Vitamin B12 or folate deficiency anaemia
Vitamin B12 or folate deficiency anaemia occurs when a lack of either of these vitamins affects the body's ability to produce fully functioning red blood cells.
Red blood cells carry oxygen around the body. Most people withvitamin B12 or folate deficiency anaemia have underdeveloped red blood cells that arelarger than normal. The medical term for this is "megaloblastic anaemia".
A vitamin B12 or folate deficiency can be the result of a variety of problems, some of which are described below.
Pernicious anaemia is the most common cause of vitamin B12 deficiency in the UK.
Pernicious anaemia is an autoimmune condition that affects your stomach. An autoimmune condition meansyourimmune system (the body's natural defence system that protects against illness and infection) attacks your body's healthy cells.
In your stomach, vitamin B12is combined withaprotein called intrinsic factor. This mix of vitamin B12 and intrinsic factor is then absorbed into the body in part of the gut called the distal ileum.
Pernicious anaemia causes your immune system to attack the cells in your stomach that produce the intrinsic factor, which meansyour body is unable to absorb vitamin B12.
The exact causeof pernicious anaemia is unknown, but the condition is more common inwomen around 60 years of age, people with a family history of the condition and those with another autoimmune condition, such as Addison's disease or vitiligo .
Some people can develop a vitamin B12 deficiency as a result of not getting enough vitamin B12 from their diet.
A diet that includes meat, fish and dairy products usually provides enough vitamin B12, but people who don't regularly eat these foods such as those following a vegan diet or who havea generallyvery poor diet can become deficient.
Stores of vitamin B12 in the body canlastaround two to four years without being replenished, so it can take a long time forany problems to develop after a dietary change.
Some stomach conditions or stomach operations can prevent the absorption ofenough vitamin B12.
For example, a gastrectomy (a surgical procedure where part of your stomach is removed) increases your risk of developing a vitamin B12 deficiency.
Some conditions that affect your intestinescan alsostop you from absorbing the necessary amount of vitamin B12.
For example, Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system) can sometimes mean your body doesn'tget enough vitamin B12.
Some types of medicine can lead to a reduction inthe amount of vitamin B12 in your body.
For example, proton pump inhibitors (PPIs) a medication sometimes used totreat indigestion can make a vitamin B12 deficiency worse. PPIs inhibit the production of stomach acid, which is needed to release vitamin B12 from the food you eat.
Your GP will be aware of medicines that can affect your vitamin B12 levels and will monitor you if necessary.
Some people can experience problems related to a vitamin B12 deficiency, despite appearing to have normal levels of vitamin B12 in their blood.
This can occur due to a problem known as functional vitamin B12 deficiency where there's a problem with the proteins that help transport vitamin B12 between cells. This results inneurological complications involving the spinal cord.
Folate dissolves in water, which means your body is unable to store it for long periods of time. Your body's store of folate is usually enough to last four months. This means you need folate in your daily diet to ensure your body has sufficient stores of the vitamin.
Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. Some are described below.
Goodsources of folate includebroccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice. If you don't regularly eat these types of foods, you may develop a folate deficiency.
Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol and people following a fad diet that doesn't involve eating good sources of folate.
Sometimes your body may be unable to absorb folate as effectively as it should. This is usually due to an underlying condition affecting your digestive system, such as coeliac disease .
You may lose folate from your body if you urinate frequently. This can be caused by an underlying condition that affects one of your organs, such as:
Some types of medicine reduce the amount of folate in your body, or make the folate harder to absorb.
These include someanticonvulsants (medication used to treat epilepsy ), colestyramine, sulfasalazine and methotrexate.
Your GP will be aware of medicines that can affect your folate levels and will monitor you if necessary.
Your body sometimes requires more folate than normal. This can cause folate deficiencyif you can't meet your body's demands for the vitamin.
Your body may need more folate than usual if you:
Premature babies (born before the 37th weekof pregnancy) are also morelikely to develop a folate deficiency, because their developing bodies require higher amounts of folate than normal.
If you're pregnant or trying to get pregnant, it's recommended that you take a 400 microgram folic acid tablet every day until you're 12 weeks pregnant. This will ensure that both you and your baby have enough folate and help your baby grow and develop.
Folic acid tablets are available with a prescription from your GP, or you can buy them over the counter from pharmacies, large supermarkets and health food stores.
If you're pregnant and have another condition that may increase your body's need for folate, such as those mentioned above, your GP will monitor you closely to prevent you from becoming anaemic.
In some cases, you may need a higher dose of folic acid. For example, if you have diabetes, you should take a 5 milligrams (5mg) supplement of folic acid instead of the standard 400 micrograms.
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Anemia caused by vitamin B12 deficiency (or folate deficiency anemia) is caused by the production of unusually large, structurally abnormal, immature red blood cells. As a result of this enlargement, the body begins to produce a smaller number of red blood cells. In this way, the red blood cells cannot effectively perform all of their usual functions. This condition is also termed megaloblastic anemia. Patients feel extremely tired, seem to have lost most of their energy, exhibit a sore, reddened tongue, muscular weakness, ulcers in the mucosa of the mouth, visual disruptions, mental issues, etc.
Megaloblastic anemia exhibits severe symptoms, especially when it becomes severe. Symptoms include: feeling extreme fatigue, lethargy, headaches, difficulties in breathing, tachycardia (palpitations), loss of appetite, yellowing skin. WIth the progression of the disease, the symptoms become increasingly aggravated and increase in number. These aggravated symptoms include: a reddening of the tongue, the tongue becomes covered in plaques, a change in the manner of walking, numbness of the muscles, ulcers in the mouth, visual problems, overall mood disorders (aggravation and depression), the manner in which the patient thinks and their memory becomes compromised, etc.
The lack of vitamin B12 in the body may cause megaloblastic anemia. This type of anemia may occur due to: 1. PERNICIOUS ANEMIA: Pernicious anemia is an autoimmune condition. In this case the immune system becomes compromised, and instead of defending the body from foreign pathogens and other infections, it attacks healthy cells in the body. Pernicious anemia is a condition which involves a defect in the stomach. In the stomach, vitamin B12 is combined to a protein called intrinsic factor. Intrinsic factor protein is crucial for the absorption of vitamin B12 in the small intestine (jejunum); without it vitamin B12 cannot be absorbed. Pernicious anemia occurs when the immune system begins to attack the healthy stomach cells which produce intrinsic factor, hence the absorption of vitamin B12 is rendered impossible. 2.DIET: Many individuals suffer from megaloblastic anemia as a result of consuming foods with insufficient amounts of vitamin B12. 3.STOMACH SURGERY: When the part of the stomach that produces intrinsic factor protein is surgically removed, the absorption of vitamin B12 is impaired. 4. MEDICATION: Using proton pump inhibitors (H2 antagonists). 5. Functional deficit of vitamin B12.
In order to diagnose anemia due to vitamin B12 deficiency, several blood tests are necessary: 1. Assessing the levels of haemoglobin in the blood. 2. Assessing the levels of erythrocytes in the blood as well as their shape. 3. Levels of B12 in the blood. 4. Assessing the levels of folates in the blood. The creation of a haemogram which includes the entire leukocyte formula, which aids a haematologist in the determination of the diagnosis. There are several indicators present in a haemogram which aid physicians in determining a diagnosis. Patients suffering from anemia usually exhibit low haemoglobin, lowered levels of erythrocytes and enlarged erythrocytes, erythrocytic volume of above 120. Leukocytes are usually lowered. Patients are referred to haematologists if the problem if haematological. If the anemia is caused by a lack of absorption in the digestive tract, a gastroenterologist. If the anemia is caused by a lack of vitamin B12 in the diet, a nutritional specialist, etc.
In order to treat megaloblastic anemia, the causes of the of the vitamin B12 deficiency must be known. The treatment is via injection or tablets to correct the deficiency. Vitamin B12 cyancobalamin or hydroxybalamin is often administered via an intramuscular injection, dosage from 100 up to 1000 gamma. Hydroxybalamin is preferred more so than cyancobalamin, because it lasts longer in the organism. is This type of therapy is used every day, or one ampoule per day depending on the condition of the patient. Patients are recommended to adjust their diet in order to consume foods that are rich in vitamin B12, such as foods rich in protein, like red meat, salmon, milk, cheese, yoghurt, butter, eggs etc. If it is the pernicious anemia causing the condition, the physician will recommend a detailed course of treatment. In this case, medication should be used for the remainder of the patient's life, in monitored doses. If the condition is caused by medication which lower the absorption of vitamin B12, the responsible medication is interrupted or substituted. If the condition is caused by a folate deficiency, folic acid in 5 mg tablets is used, 2 to 3 times a day. Green vegetables and foods high in folate content are recommended, such as peas, broccoli, chickpeas, brussel sprouts, asparagus, rice, coffee, etc. Many individuals need to take folic acid for several months. After taking the medicine for 10 to 15 days, blood tests are taken in order to monitor the levels of haemoglobin, the number of red blood cells or a complete haemogram in order to continue medication.
If megaloblastic anemia is medicated well and on time, complications are rare. If the anemia remains unmedicated, or badly medicated, the anemia may become prolonged and the following complications may occur: 1. HEART RHYTHM DISRUPTIONS (TACHYCARDIA) OR DISRUPTIONS OF BLOOD PRESSURE. 2. NEUROLOGICAL PROBLEMS: Lowered memory capabilities, visual disruptions, bad coordination in speech and movement, muscular cramps, peripheral neuropathy, etc. 3. INFERTILITY 4. STOMACH CANCER When the anemia due to vitamin B12 deficiency is caused by pernicious anemia, there is a risk of developing stomach cancer. 5. GIVING BIRTH TO BABIES WITH CONGENITAL DEFECTS 6. COLON CANCER 7. CARDIOVASCULAR DISEASE 8. PREMATURE BIRTH, ETC.