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NAME OF CAUSE DISEASE Pernicious Inadequate dietary intake (ie, anemia is a vegetarian diet) disease where Atrophy or loss

ss of gastric large, immature, mucosa (eg, pernicious nucleated cells anemia, gastrectomy, (megaloblasts, ingestion of caustic material, which are hypochlorhydria, histamine 2 forerunners of [H2] blockers) red blood cells) Functionally abnormal IF circulate in the Inadequate proteolysis of blood, and do not dietary cobalamin function as blood Insufficient pancreatic cells; it is a protease (eg, chronic disease caused pancreatitis, Zollinger-Ellison by impaired syndrome [ZES]) uptake of Bacterial overgrowth in vitamin B-12 due intestine (eg, blind loop, to the lack of diverticula) - bacteria compete intrinsic factor with the body for cobalamin (IF) in the gastric Diphyllobothrium latum (fish mucosa. It was tape worm) competes with the termed body for cobalamin "pernicious" Disorders of ileal mucosa (eg, because before it resection, ileitis, sprue, was learned that lymphoma, amyloidosis, vitamin B-12 absent IF-cobalamin receptor, could treat the Imerslnd-Grasbeck anemia, most syndrome, ZES, TCII people that deficiency, use of certain developed the drugs) disease died Disorders of plasma transport

MECHANISM/PATHOP HY Vitamin B-12 deficiency affects the nervous system, leading to a variety of symptoms. Sometimes, these may be apparent before symptoms related to the anemia. Neurological symptoms vary and may be nonspecific (meaning that these are symptoms that can be caused by a number of different conditions). Feelings of numbness, tingling, weakness, lack of coordination, clumsiness, impaired memory, and personality changes can all occur. Both sides of the body are usually affected, and the legs are typically more affected than the arms. A severe deficiency can result in more serious neurological symptoms, including severe weakness, spasticity,

TREATMENT

RECOMMENDATION IN NUTRITION The symptoms of Vitamin B-12 is pernicious anemia and derived from animal vitamin B-12 (for example, meat, deficiency can be fish, poultry, milk) treated by replenishing sources, but vitamin the vitamin B-12 B-12 deficiency in supply in the body. If a vegetarians or condition other than vegans can be pernicious anemia is prevented by the responsible for vitamin use of oral vitamin B-12 deficiency, B-12 supplements. treatment must also be An oral dose of 100directed at the 200 micrograms underlying condition. (mcg) taken weekly Symptoms of vitamin is sufficient. B-12 deficiency may be Pregnant and improved after just a nursing women who few days of medical are vegetarians or treatment. vegan should take a B-12 supplement Vitamin B-12 is and inform their typically given as an doctors they are intramuscular injection vegetarians or (shot). An injection of vegan. 1000 micrograms (1 mg) of vitamin B-12 is generally given every day for one week, followed by 1 mg every week for four weeks and then 1 mg every

from it.

of cobalamin (eg, TCII deficiency, R binder deficiency) Dysfunctional uptake and use of cobalamin by cells (eg, defects in cellular deoxyadenosylcobalamin [AdoCbl] and methylcobalamin [MeCbl] synthesis) The most common cause of pernicious anemia is the loss of stomach cells that make intrinsic factor. Intrinsic factor helps the body absorb vitamin B12 in the intestine. The loss of parietal cells may be due to destruction by the body's own immune system.

Alternative treatments for pernicious anemia Symptoms of anemia include high-dose oral are due to the reduced vitamin B-12, since a oxygen-carrying lower-efficiency capacity of the blood. absorption system for Shortness of breath, vitamin B-12 exists in fatigue, dizziness, and the intestine that does pale skin can all occur not require the with anemia. In anemia, presence of IF. the heart is placed However, the oral dose under stress since it required for this type has to work harder to of therapy (1 to 2 deliver enough oxygen milligrams/day) is to body tissues. This more than 200 times can result in heart higher than the murmurs, fast minimum daily vitamin heartbeats, arrhythmia B-12 requirement for Pernicious anemia is considered s, an enlarged adults and is to be an autoimmune disease, in heart(cardiomegaly), or significantly higher which the body's own immune even heart failure. It is than that available in system mistakenly damages its important to note that most own tissues. It is believed that not all people who have standard multivitamins the decreased absorption of vitamin B-12 deficiency and B-12 supplements. vitamin B-12 from the and neurological Nasal spray and gastrointestinal tract in symptoms will also sublingual (under the pernicious anemia results from have anemia. tongue) preparations the presence of an autoantibody of vitamin B-12 are A deficiency of vitamin against intrinsic factor (IF), a also available and are B--12 can also alter the under investigation. protein made in the stomach surface of the tongue, that is necessary for the making it appear shiny

paraplegia, andfecal and urinary incontinence.

month thereafter.

absorption of vitamin B-12. Normally, vitamin B-12 binds to intrinsic factor in the stomach, and this facilitates its absorption by the small intestine further along in the digestive process. Along with the autoimmune process that attacks the IF protein and lowers IF levels in stomach secretions, another autoimmune reaction against the stomach lining cells also occurs, resulting in a form of inflammation known as chronic atrophic gastritis. Pernicious anemia is sometimes associated with other autoimmune diseases such asGraves' disease, Hashimoto's thyroiditis andvitiligo (depigme ntation or blanching of skin areas).

or smooth. Finally, sometimes pernicious anemia is diagnosed in a patient with no symptoms. In these cases, it is usually found incidentally when blood tests are ordered for another reason.

http://emedicine.medscape.com/article/204930-overview#showall

http://www.medicinenet.com/pernicious_anemia/page5.htm

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