Megaloblastic (Pernicious) Anemia

What is megaloblastic (pernicious) anemia?
Megaloblastic (pernicious) anemia is a rare disorder in which the body does not absorb enough vitamin B12 from the digestive tract, resulting in an inadequate amount of red blood cells (RBCs) produced.

What causes megaloblastic (pernicious) anemia?
Megaloblastic (pernicious) anemia is more common in individuals of northern European descent. Megaloblastic (pernicious) anemia results from a lack of intrinsic factor in gastric secretions (a substance needed to absorb vitamin B12 from the gastrointestinal tract). Vitamin B12 deficiency results.

The inability to make intrinsic factor may be the result of chronic gastritis, or the result of a gastrectomy (removal of all or part of the stomach). Megaloblastic (pernicious) anemia may also be associated with type 1 diabetes, thyroid disease, and a family history of the disease.

What are the symptoms of megaloblastic (pernicious) anemia?
The following are the most common symptoms for megaloblastic (pernicious) anemia. However, each individual may experience symptoms differently. Symptoms may include:

• weak muscles
• numbness or tingling in hands and feet
• difficulty walking
• nausea
• decreased appetite
• weight loss
• irritability
• lack of energy or tiring easily (fatigue)
• diarrhea
• smooth and tender tongue
• increased heart rate (tachycardia)

The symptoms of megaloblastic (pernicious) anemia may resemble other blood conditions or medical problems. Always consult your physician for a diagnosis.

How is megaloblastic (pernicious) anemia diagnosed?
Megaloblastic (pernicious) anemia is usually discovered during a medical examination through a routine blood test. In addition to a complete medical history and physical examination, diagnostic procedures for megaloblastic (pernicious) anemia may include additional blood tests and other evaluation procedures, including the Schilling test.

The Schilling test is performed to detect vitamin B12 absorption. In the Schilling test, vitamin B12 levels are measured in the urine after the ingestion of radioactive vitamin B12. With normal absorption, the ileum (portion of the small intestine) absorbs more vitamin B12 than the body needs and excretes the excess into the urine. With impaired absorption, however, little or no vitamin B12 is excreted into the urine.

Treatment for megaloblastic (pernicious) anemia:
Specific treatment for megaloblastic (pernicious) anemia will be determined by your physician based on:

your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
Treatment may include vitamin B12 injections.

Foods that are rich in folic acid include the following:

• orange juice
• oranges
• romaine lettuce
• spinach
• liver
• rice
• barley
• sprouts
• wheat germ
• soy beans
• green, leafy vegetables
• beans
• peanuts
• broccoli
• asparagus
• peas
• lentils
• wheat germ
• chick peas (garbanzo beans)

Foods that are rich in folic acid and vitamin B12 include the following:

• eggs
• meat
• poultry
• milk
• shellfish
• fortified cereals