Vitamin B12 or folate deficiency anaemia
A diagnosis ofvitamin B12 or folate deficiency anaemia canoften be made by your GP based on your symptoms and the results of blood tests .
Different types of Blood tests can be carried out tohelp identify people with a possiblevitamin B12 or folate deficiency. These tests check:
However, some people can have problems with their normal levels of these vitaminsor mayhave low levels despite having no symptoms.This is why it's important for your symptoms to be taken into account when a diagnosis is made.
A particular drawback of testing vitamin B12 levels is that the current widely-used blood test only measures the total amount of vitamin B12 in your blood.
This meansit measuresforms of vitamin B12 that are "active" and can be used by your body, as well as the "inactive" forms, which can't. If a significant amount of the vitamin B12 in your blood is "inactive", a blood test may show that you have normal B12 levels,even though your body can't use much of it.
There are some types of blood test thatmay help determine if the vitamin B12 in your blood can be used by your body, but these aren't yet widely available.
If your symptoms and blood test results suggest a vitamin B12 or folate deficiency, your GP may arrange further tests. If the cause can be identified,it willhelpto determine the most appropriate treatment.
For example,you may have additional blood tests to check for a condition called pernicious anaemia. This is an autoimmune condition (where your immune system produces antibodies to attack healthy cells), which means you're unable to absorb vitamin B12 from the food you eat.
Tests for pernicious anaemia aren't always conclusive, but they can oftengive your GP a good idea of whether you have the condition.
You may be referred to a specialist for further tests or treatment. This may include:
Adietitian can devise a personalised eating plan for you to increase the amount of vitamin B12 or folate in your diet.
Read our page on B vitamins and folic acid for information about good sources of these vitamins.
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.