Why is pernicious anemia treated with injections

Shots usually are given in a muscle every day or every week until the level of vitamin B12 in your blood increases. After your vitamin B12 blood level returns to normal, you may get a shot only once a month.

For less severe pernicious anemia, your doctor may recommend large doses of vitamin B12 pills. A vitamin B12 nose gel and spray also are available.

These products may be useful for people who have trouble swallowing pills, such as older people who have had strokes. Your signs and symptoms may begin to improve within a few days after you start treatment. Your doctor may advise you to limit your physical activity until your condition improves.

If your pernicious anemia is caused by something other than a lack of intrinsic factor, you may get treatment for the cause if a cause can be found. For example, your doctor may prescribe medicines to treat a condition that prevents your body from absorbing vitamin B If medicines are the cause of your pernicious anemia, your doctor may change the type or dose of medicine you take.

Infants of strict vegetarian mothers may be given vitamin B12 supplements from birth. Signs and Symptoms How is Anemia Diagnosed? How is Anemia Treated? How Can Anemia Be Prevented? We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.

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Close Back. Sign in. Join now. But if you need replacement tablets of vitamin B12, these will usually be in the form of cyanocobalamin. To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. Most people need to take folic acid tablets for about 4 months. But if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer, possibly for life. Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal.

This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency. To ensure your treatment is working, you may need to have further blood tests. A blood test is often carried out around 10 to 14 days after starting treatment to assess whether treatment is working. This is to check your haemoglobin level and the number of the immature red blood cells reticulocytes in your blood. Another blood test may also be carried out after approximately 8 weeks to confirm your treatment has been successful.

If you have been taking folic acid tablets, you may be tested again once the treatment has finished usually after 4 months. The RCT by Bolaman et al. The other two prospective studies by Nyholm et al. The studies were conducted during the period of late s to early s.

Five of the patients who had pernicious anemia in the oral vitamin B12 replacement group all had increase in serum vitamin B12 level. Four of the 18 in the oral group and 4 of the 15 in the IM group had a neurological response with a marked improvement or clearing of paresthesia, ataxia, or memory loss. Both groups reported improvements of cognitive functions, sensory neuropathy, and vibration sense, but there was no statistical significant difference between both groups.

The systematic review by Butler et al. However, the two RCTs were limited by their small sample size and short follow-up period. An increase in vitamin B12 level was as much as fourfold compared with pretreatment in most patients. The mean change of It was also reported that using oral treatment did not result in any new neurological complications. There was a dose-finding trial done by Eussen et al.

However, this study did not distinguish the extent to which differences in individual responses were due to active as opposed to passive absorption of vitamin B In some of the clinical reviews, it was stated that many do not use oral vitamin B12 replacement in view of concern on the unpredictable absorption at low doses of oral replacement. Improvement in vitamin B12 was seen as early as within a month. Close monitoring monthly is necessary at the start of oral replacement to verify normalization of lab results and monitoring for symptoms.

Thereafter, annual monitoring should suffice. It should be carried out on a regular interval that is safe for patients and acceptable to both patients and doctors.

It has been recommended that serum total homocysteine Hcy and methylmalonic acid MMA levels are more sensitive indicators of vitamin B12 status in pernicious anemia patients without any other disorders of vitamin B12 metabolism. In our review, some 10 , 13 , but not all, studies determine metabolite levels Hcy and MMA in pernicious anemia to assess effectiveness of therapy with vitamin B Most patients with pernicious anemia are not screened genetically for confirmatory causes of the disease.

There are genetic errors of metabolism where serum vitamin B12 levels are normal, but there is a functional cellular level deficiency of the micronutrient that is often overlooked unless Hcy and MMA levels are also measured. The levels decrease immediately after treatment and repeat measurements have clinical utility to document adequate vitamin B12 replacement. However, considerations of using Hcy and MMA levels would include cost, availability of the test, as well as having standardized reference intervals.

Patients with vitamin B12 deficiency who are symptomatic have severe neurological deficits or have critically low blood levels of vitamin B12 should be treated with IM administration. This is to ensure rapid replenishment of body stores to prevent irreversible consequences of deficiency.

Subsequently, patients may be able to convert to oral replacement with close monitoring. For long-term maintenance therapy, oral vitamin B12 replacement can be effective in patients with pernicious anemia. Patient preference should be taken into consideration in the choice of treatment options.

Few studies had included surveying patients regarding preference of choice between oral vs. IM replacement of vitamin B Additional factors to consider when helping patient to make an informed choice are as follows. In a study done in United Kingdom by Vidal-Alaball et al.

The use of oral route results in significant reduction in manpower costs. Many patients with vitamin B12 deficiency are elderly and have multiple co-morbidities. They often have multiple appointments to attend various clinics and may have frequent hospitalization episodes. The need to schedule vitamin B12 injections is an avoidable addition to the cost and complexity of their care.

In patients with non-compliance to oral medication, IM route may be a better option to ensure timely administration. On the other hand, oral replacement may improve adherence for patients who prefer oral medication to injections. Oral replacement will be useful in patients who are averse to injection. For elderly patients with sarcopenia, injections can painful and difficult to administer. Oral replacement is the best option. Studies were mainly on patients with vitamin B12 deficiency with a subset of patients with pernicious anemia.

Therefore, the actual sample size of pernicious anemia patients in each study may not reach statistical significance. Many of the studies had small sample size and assessed only short-term outcomes.

The long-term efficacy and side effects require further evaluation. A multicenter randomized clinical trial is current in progress in Spain primary health-care setting called Project OB12 Further studies should include testing the efficacy of different dosages.

Close monitoring with clinical review and repeat vitamin B12 levels are required on a monthly basis to review symptoms and ensure normalization of B12 deficiency. Elevated serum Hcy and MMA levels should be included in future assessments of pernicious anemia and corrected with normal levels in patients with pernicious anemia.