Pernicious Anemia

Pernicious anemia is a common cause of cobalamin/vitamin B12 deficiency. It is primarily a disease of the elderly and caused by an abnormality in the immune system where the body creates antibodies to intrinsic factor (a substance that facilitates absorption of vitamin B12) or to the cells in the stomach that secrete it. The lack of intrinsic factor B12 leads to vitamin B12 deficiency. It can also be caused by physiologic or anatomic disturbances of the stomach that might prevent intrinsic factor secretion. In children, an atypical and rare form of pernicious anemia can be inherited. It is an autosomal recessive disorder that results in an inability to secrete intrinsic factor, and it presents with anorexia, weakness, a painful red tongue, and neurologic abnormalities.

fortified with iron, folate, or vitamin B12. Given adequate resources, these deficiencies can also be ameliorated with direct oral supplements of absorbable iron, vitamin B12, and folic acid. Injectable forms of iron are also available. It has been found that the supplementation of vitamin A to at-risk populations improves anemia more efficiently than iron supplementation alone.

Treatment plans must also focus on the causes of anemia and therefore must include sanitation, treatment of infections such as malaria and HIV, and, most important, treatment of intestinal parasites. Much work is needed to address general malnutrition—not only concerning these deficiencies, but also other commonly occurring ones (e.g., vitamin A, zinc, copper, calcium). Programs dedicated to decreasing the rates of infection and illness in developing countries—through health education, immunization, sanitation, and appropriate treatment—will also contribute to a lower incidence and prevalence of worldwide anemia. see also Kwashiorkor; Malnutrition; Marasmus; Nutritional Deficiency; Vitamins, Water Soluble.

Seema P. Kumar

Bibliography

Behrman, Robert E.; Kliegman, Robert M.; and Jenson, Hal B., eds. (2000). Nelson Textbook of Pediatrics, 16th edition. Philadelphia, PA: W. B. Saunders.

Hoffbrand, A. V., and Herbert, V. (1999). "Nutritional Anemias." Seminars in Hematology 36(4).

Isselbacher, Kurt J. (1994). Harrison's Textbook of Internal Medicine, 13 th edition. New York: McGraw-Hill.

Pollitt, E. (2000). "Developmental Sequela from Early Nutritional Deficiencies: Conclusive and Probability Judgments." Journal of Nutrition 130.

Ramakrishnan, U., ed. (2001). Nutritional Anemias. Boca Raton, FL: CRC Press.

Rhoades, R. A., and Tanner, G. A. (1995). Medical Physiology. Boston: Little Brown.

Yip, R., and Ramakrishnan, U. (2002). "Experiences and Challenges in Developing Countries." Journal of Nutrition 132.

fortified: altered by addition of vitamins or minerals parasite: organism that feeds off of other organisms malnutrition: chronic lack of sufficient nutrients to maintain health zinc: mineral necessary for many enzyme processes calcium: mineral essential for bones and teeth incidence: number of new cases reported each year

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