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Pernicious anemia is the most common cause of vitamin B 12 deficiency anemia in adults, which results from malabsorption of vitamin B 12 due to a lack or loss of intrinsic factor. [2] [8] There are relatively few studies which have assessed the impact of haematological measures in response to B 12 supplementation.
Vitamin B 12 has a major function in the nuclear replication of the DNA. It is therefore logical that its deficiency causes decrease bone marrow production, one of the most common manifestations of which is decreased red blood cell production or as it is referred to medically, anemia. Vitamin B 12 however has two major forms in the human body: [6]
Other causes of B12 malabsorption include intrinsic factor deficiency, pernicious anemia, bariatric surgery pancreatic insufficiency, obstructive jaundice, tropical sprue and celiac disease, and radiation enteritis of the distal ileum. [121] Age can be a factor.
As a result of the concomitant vitamin and mineral deficiencies that occur as a result of the malabsorption associated with blind loop syndrome patients with advanced cases should be investigated for: [citation needed] Vitamin B12 deficiency; Folate deficiency; Iron deficiency; Vitamin E deficiency
Neuropsychiatric symptoms can precede hematological signs and are often the presenting manifestation of the disease. [55] Vitamin B 12 serum levels are used to detect its deficiency, but do not distinguish its causes. Vitamin B 12 levels can be falsely high or low and data for sensitivity and specificity vary widely.
For example, there is increasing epidemiologic evidence that more patients with coeliac disease present with anemia and osteopenia in the absence of significant classic gastrointestinal symptoms. Microcytic, macrocytic, or dimorphic anemia may reflect impaired iron, folate, or vitamin B12 absorption.
The disease can also be caused by inhalation of nitrous oxide, which inactivates vitamin B12. [11] Vitamin E deficiency, which is associated with malabsorption disorders such as cystic fibrosis and Bassen-Kornzweig syndrome, [12] can cause a similar presentation due to the degeneration of the dorsal columns. [5]
Dietary deficiency of vitamin B 12 occurring in strict vegetarians and in their breastfed infants (isolated vitamin B 12 deficiency is very rare) Malabsorption of vitamin B 12 resulting from damage to the stomach, where intrinsic factor is secreted, or damage to the ileum, where intrinsic factor facilitates vitamin B 12 absorption.