B12 deficiency anemia
B12 deficiency anemia - a set of clinical and gemotologicheskih symptoms resulting from changes in the morphology of erythrocytes and disturbance of synthesis of RNA and DNA in the bone marrow cells of hematopoiesis.The body of every adult needs systematic replenishment of vitamin B12, which are the main sources of food of animal origin.To perform normal hematopoiesis body should be no more than 7 mg cyanocobalamin per day.Feature of vitamin B12 absorption is the mandatory presence of gastric biermerin binding cyanocobalamin in the complex.
After entering the complex with cyanocobalamin in the small intestine are activated processes of absorption and intake of vitamin B12 in the flow of peripheral blood and deposit it in the liver and bone marrow tissue.To process megaloblastic hematopoiesis but maintain normal levels of vitamin B12, it is imperative to maintain the level of folic acid.To maintain adequate levels of folic acid in the body, it is indispensable to its r
Vitamin B12 acts as an activator of folic acid, which is directly involved in the metabolism of nucleic acids that are crucial in the process of erythropoiesis.
reasons B12 deficiency anemia
Group risk B12-deficiency anemia are men of advanced age, chronic diseases of the digestive system.
B12, folic acid deficiency anemia belongs to the category polyetiology diseases, the occurrence of which is influenced by a number of reasons, each of which can be attributed to one of the two main mechanisms - a violation of the process of absorption of cyanocobalamin or excess of its expenditure.
Violation of absorption of vitamin B12 and folic acid can be triggered by a number of etiologic factors, of which the most frequently encountered:
- the presence of atrophy of fundic glands in the projection of the stomach responsible for producing biermerin;
- partial gastrectomy;
- the presence of large space-occupying lesions in the stomach cavity (polyps, cancer, teratoma, bezoar);
- thermal injuries of the gastric mucosa;
- violation of the synthesis of granulocytes biermerin parietal gastric mucosa as a result of autoimmune disorders in the body;
- toxic damage of the mucous membrane of the stomach and small intestine of alcohol and chemicals;
- chronic enteritis with atrophic disorders duodenal mucosa, accompanied by violation of the processes of absorption.
Increased consumption of the vitamin B12 occurs when helminthic invasion (diphyllobothriasis) released diverticulosis localized in the small intestine and chronic liver pathologies.Megaloblastic anemia occurs not only in low levels of vitamin B12, but with a decrease in the body of folic acid, which develops in celiac disease, blind loop syndrome, chronic administration of folic acid antagonists, alcoholism.Physiological reduction of folic acid occurs only during pregnancy and its admission to the lack of food.
pathogenetic mechanisms of megaloblastic hematopoiesis based on the type of violation of DNA synthesis erythroblasts and longer maturing erythroid elements.When megaloblastic hematopoiesis observed type selection in the peripheral blood stream of a modified form of red blood cells, in which there is a large percentage of the hemoglobin to the presence of inclusions in the form of rings and Jolly corpuscles Kebota.
mechanism raising indirect bilirubin in the blood due to increased destruction of red blood cells in the spleen changed.As with all other types of anemia, megaloblastic anemia is accompanied by a significant reduction in the period of life of red blood cells.Pathogenesis of funicular myelosis, which is one of the manifestations of B12 deficiency anemia is based on the violation of succinic acid synthesis and accumulation of toxic acid methylamine.
Symptoms of B12 deficiency anemia
typical clinical picture with the B12-folievodefitsitnoy anemia develops gradually and is characterized by symptoms of central nervous system, digestive tract, and the appearance of the characteristic symptoms of anemia.
Long before the appearance of signs of reduction of red blood cells in peripheral blood of patients with megaloblastic anemia complain of increasing weakness and decreased ability to work, the appearance of a burning sensation in the mouth, loss of appetite.If severe clinical symptoms of B12 deficiency anemia occurs in a patient develop pain in the epigastric region aching, regurgitation of stomach contents, and dyspepsia (nausea and vomiting associated with taking on the food preferences of taste perversion, frustration of a chair).
specific signs of B12 deficiency anemia is the appearance of a constant compressive headache without irradiation, weakness in the lower limbs during long walking, numbness of the peripheral parts of the upper and lower extremities, the appearance of paresthesias and violation of skin sensitivity.
At the initial examination of a patient with B12 deficiency anemia, severe degree of observed pale skin with a lemon-yellow shade, ikterichnost mucous membranes of the mouth and conjunctiva, pasty face and lower extremities.Typical symptoms of megaloblastic anemia objective is to change the language of the mucous membrane with the appearance of papillae atrophy and signs of inflammatory changes in the form of redness and the presence of the AFL.
symptoms of central nervous system B12 deficiency anemia is a violation of both superficial and deep sensitivity, reduction reaction in the study of tendon reflexes and the development of muscle atrophy of various localization.The appearance of the patient's visual and auditory hallucinations, and delusions occurrence indicates the progression of B12 deficiency anemia.
Symptoms defeat of the cardiovascular system are rare and are a sign of severe B12 deficiency anemia.The most characteristic changes in this situation are: acceleration of heart rate, the appearance of systolic murmur in all points of auscultation, and an increase in relative and absolute boundaries of cardiac dullness.
isolated folate deficiency subject to the preservation of vitamin B12 in the body is accompanied by signs of glossitis and the complete absence of neurological symptoms.
Diagnostics B12 deficiency anemia
informative and accessible in the application of the method of diagnosis of B12-deficiency anemia folievodefitsitnoy a full blood count.When B12-deficiency anemia in the composition of peripheral blood formed characteristic changes as a violation of the shape and size of red blood cells (macrocytosis, poikilocytosis), the appearance of the erythrocyte the remnants of nuclear substance (calf Jolly, rings Kebota), as well as increased color index.
Typical manifestations Megaloblastic type of anemia that distinguishes it from other forms of anemia, is a combination of symptoms of anemia with moderate leukopenia and the emergence of giant neutrophil gipersegmentirovannym kernel.For B12-deficiency anemia is not typical folievodefitsitnoy reticulocytosis, even taking into account the decline in absolute numbers of reticulocytes.
In a situation such as hindered diagnosis megaloblastic hematopoiesis patient recommended implementation of sternal puncture and examination of punctate for Hyperplasia of red sprout and availability megaloblasts.
With a view to distinguishing deficit cyanocobalamin and folic acid recommended by the study of blood serum microbiological and radioimmunoassay to determine the quantitative and qualitative content of vitamin B12.The criterion for reducing cyanocobalamin in the body is the detection of methylmalonic acid in the urine sample.
Biochemical blood is accompanied by a high level of bilirubin due to its indirect fraction.
Treatment B12 deficiency anemia
treatment the patient should be engaged hematologist with specialists narrow profile, if necessary (gastroenterologist, neurologist, oncologist and a physiotherapist).The amount of therapeutic measures to a greater degree depends not on the degree of B12 deficiency anemia and on the presence of a violation of the cardiovascular, digestive and central nervous systems.
Unlike other forms of anemia, vitamin B12 deficiency anemia folievodefitsitnoy hard cured drug-free methods that should be used only as additional activities.Among the non-drug methods for correction of deficiency of vitamin B12 and folic acid is most important correction of eating behavior and the elimination of factors contributing to the disease (alcohol and drugs certain groups, for example, most anticonvulsants).
adequate etiopathogenetic therapy selection criterion is mandatory in order to achieve positive results in the treatment of B12 deficiency anemia.For this purpose, it is recommended to pay most attention to the diagnosis of the underlying disease, which is an agent provocateur of anemia, and selection of individual treatment regimens.Thus, when existing intestinal helminthiasis deworming with appropriate use of mandatory compliance with the dosage of the drug (fenasal a daily dose of 3 g orally) and permanent control of fecal analysis.
In a situation where B12 deficiency anemia occurs in severe form and the appearance of it is due to the presence of space-occupying lesions in the intestines and stomach, the patient shows surgery.In order to improve digestive and intestinal absorption of particular importance should be given to the normalization of the intestinal flora, and therefore, patients are recommended long-term use Latsidofila 2 capsules 2 p. / Day, as well as enzymatic drugs (Mezim 1 tablet during each meal).
as pathogenetic treatment of B12 deficiency anemia used types of parenteral administration of cyanocobalamin.The dosage of the drug depends on the severity of vitamin B12 deficiency and related anemia syndrome.Most often used such a scheme is the use of cyanocobalamin: the first 10 days of 500 mg 2 p / day, the next month the drug is administered 1 time per week at a dose of 500 mg, followed by six months the drug is taken once a month 1 500 mg.Preferred is intramuscular or subcutaneous infusion type.
In a situation when diagnosed B12 deficiency anemia caused by autoimmune disorders, pathogenetically justified is the appointment of prolonged corticosteroid therapy (prednisolone at a daily dose of 20 mg orally).
Exchange transfusion of whole blood and packed red blood cells in the B12-deficiency anemia is the exception rather than the rule and its application is justified only in case of severe illness.The volume of transfusion is not more than 250 ml of RBC infusion rate 5-6.
the indications of folic acid daily in a therapeutic dose of 4 mg is it confirmed by laboratory methods deficit.