Is this dangerous anemia the cause of constant fatigue? (Pernicious Anemia)

Do you feel tired all the time? Do you feel weak even after walking for a short while? Do you feel like you don't have any appetite, and do you look pale? Most of the time, we don't pay much attention to these things, thinking that they are normal. However, there may be a serious reason behind this. Today, we are talking about a somewhat serious but treatable condition caused by vitamin B12 deficiency. We call this Pernicious Anemia .

Simply put, what is Pernicious Anemia?

Pernicious Anemia is one of the main causes of vitamin B12 deficiency. To be precise, this is an autoimmune condition . Now you may be wondering what an autoimmune condition is. Simply put, the main job of our immune system is to fight off foreign invaders and protect us from disease. However, in this condition, our own immune system mistakenly starts attacking our own healthy cells.

Something similar happens in Pernicious Anemia. Our immune system attacks certain cells in the intestines (stomach). These cells produce a special protein called Intrinsic Factor that helps the body absorb vitamin B12. When this protein is missing, no matter how much vitamin B12 we eat, it is not absorbed by the body and is wasted.

Vitamin B12 is very important for our body. In particular, it is essential for the production of red blood cells, which carry oxygen in the blood. So, when vitamin B12 is lacking, the production of healthy red blood cells decreases. This is what we call anemia .

How does this condition affect my body?

Pernicious anemia can affect several body systems.

• Digestive system: Nausea, bloating, and weight loss may occur.
• Nervous system: This is the most dangerous. It can lead to muscle weakness, numbness in the limbs, memory loss, and even dementia.
• Heart: You may experience palpitations or irregular heartbeats.
• General health: Constant fatigue and weakness are the main symptoms.

This condition is most commonly seen between the ages of 60 and 80, especially among people of Northern European descent.

What are the symptoms of Pernicious Anemia?

One of the unique things about this is that it can take years for symptoms to appear. This is because our body stores vitamin B12 in the liver and uses it little by little. This storage can take about 3-5 years to run out. Even then, it takes a while for symptoms to appear.

As vitamin B12 levels decrease, symptoms become more severe. You can get a good idea of ​​this from the table below.

Are there other causes of Pernicious Anemia?

Yes. In addition to the autoimmune condition called Pernicious Anemia, the body may not be able to absorb vitamin B12 for other reasons.

• Stomach surgery: When surgery is performed to remove part or all of the stomach (e.g. gastric bypass surgery for obesity), the cells that help absorb vitamin B12 are lost.
• Small intestine surgery: Removing part of the small intestine reduces the ability to absorb vitamin B12.
• Small Intestinal Bacteria: In a condition called Small Intestinal Bacterial Overgrowth (SIBO) , bad bacteria grow in the small intestine and eat up vitamin B12 before it can be absorbed by the body.
• Some medications: Some medications for diabetes, epilepsy, and some antibiotics can affect vitamin B12 levels.
• Tapeworm Infections: Eating undercooked, infected fish can cause tapeworm infections. These parasites feed on vitamin B12.
• Diet: People who are completely vegan or follow a plant-based diet may lack sufficient vitamin B12 in their diet.
• Other diseases: Digestive system diseases like Celiac disease or Crohn's disease make it difficult to absorb vitamin B12.
• Hormonal diseases: People with autoimmune conditions such as hypoparathyroidism and Graves' disease are at increased risk of developing pernicious anemia.

How do you find this, Doctor?

If you have these symptoms, it's important to see your doctor. He or she will examine you, take your medical history, and order several tests to confirm the condition.

• Vitamin B12 level test: This measures how much vitamin B12 is in the blood.
• Complete Blood Count (CBC): This can determine the type and severity of anemia.
• Other special blood tests: Tests such as Reticulocyte count, LDH, Serum bilirubin, MMA, Homocysteine ​​level, etc., provide in-depth information on vitamin B12 deficiency and bone marrow function.
• Antibody test: This tests the blood for antibodies that attack stomach cells and intrinsic factor.
• Upper Endoscopy: A tube-like camera (endoscope) is inserted through the mouth and the inner lining of the stomach is examined.

How is it treated? Will it get better?

There is a treatment for this, and that's the best news! Since your body can't absorb vitamin B12, your doctor will first prescribe you vitamin B12 injections . These are given directly into a muscle, so they go straight into your bloodstream without going through the stomach.

Once your vitamin B12 levels have returned to normal, you may be advised to continue taking high-dose vitamin B12 tablets (oral B12 replacement). Your doctor will continue to monitor your condition and adjust your treatment.

You will start to feel significant relief within a few days of starting treatment. However, it may take several weeks for your symptoms to completely subside and you will feel better.

But remember, the damage to the nervous system may not be fully reversible even with vitamin B12. Therefore, it is very important to diagnose the disease and start treatment early.

How do I take care of myself?

If you have Pernicious Anemia, you will need to take vitamin B12 for the rest of your life, as prescribed by your doctor. It is a must.

If you have a B12 deficiency due to other reasons, changing your diet can also help. Foods rich in vitamin B12 include:

• Meats such as beef, liver, chicken, and fish
• Eggs and dairy products (milk, yogurt, cheese)
• Breakfast cereals with added vitamin B12
• Soy products with added vitamin B12

It's a good idea to talk to your doctor and get advice on a diet that's right for you.