B12 deficiency anemia - symptoms and treatment

Indications for analysis

MCV blood test is not the only one. To clarify the diagnosis, the therapist may require a retake or refer it for additional tests.

MCV is informative in two cases:

• in order to diagnose one of the types of anemia;
• to determine the type of water-salt imbalance. People are often sent for such an analysis if they have various intestinal infections, acute respiratory diseases and ARVI.

Other, no less serious, reasons for getting tested may be:

• failure of the hormonal system;
• metabolic problems;
• overweight;
• increased blood sugar or diabetes;
• a sharp and causeless decrease in the level of the immune system.

MCV analysis results often help identify such deviations:

• anemia of normochromic type. It is fixed when pathologies appear in the bone marrow, sometimes caused by chronic diseases;
• macrocytic type anemia. It is characterized by an excessive increase in mcv. Red blood cells increase in size due to insufficient amounts of vitamin B and folic acid;
• microcytic anemia. In this case, the disease occurs due to a lack of iron in the blood.

B12 deficiency anemia - symptoms and treatment

To correctly diagnose B12DA, an examination by a hematologist is important. To clarify and correct problems associated with the gastrointestinal tract, you will need to consult a gastroenterologist. An examination by a neurologist may be necessary to evaluate neurological manifestations.

Patient examination

During examination, the doctor may notice pallor and slight jaundice of the skin, an increase in heart rate and expansion of the boundaries of the heart. It is necessary to examine the oral cavity, especially the tongue. A neurologist can assess muscle tone and the presence of pathological reflexes.

Laboratory diagnostics

One of the most important stages of diagnosis is the evaluation of a clinical blood test . The analysis shows:

• decreased hemoglobin - anemia;
• macrocytosis - the presence in the blood of a large number of abnormally large red blood cells (macrocytes);
• hyperchromia - intense staining of red blood cells caused by an increased amount of hemoglobin in the blood;
• a decrease in the number of leukocytes and platelets may be observed.

It is necessary to perform a blood smear , in which a morphologist can see pathological forms of red blood cells:

• ovalocytes (oval-shaped red blood cells) and degenerative forms;
• an increase in the difference in erythrocyte size (RDW parameter);
• specific pathological inclusions, such as Jolly bodies and Cabot rings;
• megalocytes and megaloblasts - in severe cases.

Pathological forms of neutrophils may also occur:

• giant neutrophils;
• neutrophils with nuclear hypersegmentation (5 or more segments);
• metamyelocytes are immature neutrophilic leukocytes.

The number of young forms of red blood cells (reticulocytes) is usually reduced. If laboratory capabilities are available, additional useful information can be provided by reticulocyte indices: the average volume of reticulocytes and the average hemoglobin content in reticulocytes increases, the fraction of immature reticulocytes increases [1][2][4][5].

In a biochemical blood test:

• decreased levels of vitamin B12;
• indirect bilirubin and lactate dehydrogenase may be increased - a sign of early destruction (hemolysis) of red blood cells in the blood and the breakdown of red blood cell precursors in the bone marrow [4];
• Iron and ferritin levels are normal.

It is imperative to evaluate folic acid levels , since changes in clinical analysis for B12 and folic acid deficiency are similar, but treatment is different. If B12DA is suspected, but vitamin B12 and folic acid levels are normal, serum holotranscobalamin (active vitamin B12) determination is recommended. In case of B12 deficiency, its content is reduced. Increases in serum homocysteine ​​and methylmalonic acid levels may be detected [2][3].

In a general urine test, persistent proteinuria may be observed - the appearance of protein in the urine. In some cases, there is an increase in the level of methylmalonic acid and homocysteine.

Additional laboratory tests that may help identify the cause of vitamin B12 deficiency:

• study of antibodies to internal Castle factor (IgG) and gastric parietal cells in blood serum;
• examination of gastric juice to identify internal Castle factor and antibodies to this factor (IgA, synthesized by parietal cells of the stomach);
• Schilling test - determines the activity of the intrinsic factor of Castle and the absorption of vitamin B12 in the intestines;
• tests for malabsorption (impaired absorption of nutrients) [5].

Prenatal diagnosis of genetically determined deficiency of the transport protein transcobalamin II is possible

Instrumental diagnostics

Ultrasound examination of the abdominal organs can detect minor hepatosplenomegaly - enlargement of the liver and spleen.

To identify diseases of the gastrointestinal tract that may interfere with the absorption of vitamin B12, all patients with newly diagnosed B12DA are recommended to undergo endoscopic examinations - fibrogastroduodenoscopy (EGD) and colonoscopy . FGDS may reveal chronic atrophic gastritis, duodenitis, and a decrease in gastric secretion may be observed. In the presence of pathological changes, it is necessary to perform a biopsy of the gastric mucosa with further histological examination [3][4].

Differential diagnosis

Differential diagnosis for B12-deficiency anemia, especially with a decrease in leukocytes and platelets, is carried out with the following diseases of the blood system:

• Myelodysplastic syndrome is a group of hematological diseases in which the bone marrow does not produce enough of one or more types of blood cells: platelets, white blood cells, red blood cells.
• Aplastic anemia is anemia that occurs due to insufficient production of red blood cells due to a decrease in the number of hematopoietic stem cells.

To clarify the diagnosis, it may be necessary to perform a bone marrow puncture and its morphological examination. If B12DA is present, a morphologist describes characteristic changes in stem progenitor cells in the bone marrow:

• hyperplasia (proliferation) of the erythroid germ - stem progenitor cells from which red blood cells are formed;
• megaloblastic type of hematopoiesis, in which large cells with granular nuclei, pathological mitoses, and Jolly bodies are formed;
• impaired maturation of myeloid cells and platelet precursors: giant metamyelocytes, hypersegmentation of neutrophils, multinucleated megakaryocytes [1][2][3][4].

Normal MCV values

In children under 10 years of age, the index may fluctuate and be inaccurate; later it returns to normal (80-100 fl).

MCV is higher than normal

If the results are above normal, this indicates the development of macrocytic anemia. It can be directly related to diseases such as:

• drug intoxication;
• food poisoning;
• problems with the thyroid gland;
• lack of iodine or iron in the body;
• liver dysfunction;
• oncological process of red bone marrow;
• long-term alcoholism;
• disruption of the pancreas.

An increase in mcv can be caused by:

• long-term use of birth control pills that affect hormonal levels;
• addiction to cigarettes and tobacco products;
• prolonged contact with toxic substances (work in hazardous industries);
• taking medications that increase the level of mcv in the blood.

If left untreated, macrocytic anemia can lead to frequent fainting, poor health, and low hemoglobin levels in the blood. Particularly at risk are:

• people who eat poorly, lead a sedentary lifestyle and ignore exercise;
• patients with chronic liver failure;
• people with a genetic predisposition to the disease;
• men over fifty-five years of age who abuse alcohol.

Experts identify some signs by which one can understand that a person’s red blood cell volume is too high:

• unhealthy pale lips;
• abdominal pain for no particular reason, which appears very often;
• the presence of tachycardia (heartbeat too fast), even when the person is at rest;
• skin with a yellowish tint.

If you notice similar symptoms or detect an increased level of mcv in the blood, you must immediately consult a general practitioner for appropriate treatment.

Why is MCV lowered?

If the MCV indicator in a blood test is low (does not reach the required 80 fl), most often this indicates that the child or adult is developing some form of anemia, that is, a lack of hemoglobin in red blood cells. Thanks to the compensatory properties of blood, the number of red blood cells themselves can increase, but all of them will poorly supply oxygen to the tissues and organs of a sick person.

The reasons for the decrease in the average volume of red blood cells may be the following conditions and pathologies:

• Iron deficiency anemia (grade 2-3) is a lack of iron, which the body receives from food or in the form of vitamin-mineral complexes. Often develops against the background of gastrointestinal diseases and microelement absorption disorders, intestinal tumors, gastritis with low acidity. Pregnancy can also lead to iron deficiency.
• Lack of folic acid, often also associated with pregnancy.
• Chronic diseases associated with constant blood loss: hemorrhoids, nosebleeds, peptic ulcers, etc.
• If the indicator in women is below normal, this may indicate the development of uterine tumors (fibroids, fibroids, or malignant ones). These diseases are characterized by frequent bleeding not associated with menstruation.
• A pathology of the red bone marrow that results in insufficient production of normal blood cells (congenital sideroblastic anemia). In addition to the congenital form, the disease can develop due to lead poisoning and taking a number of medications.
• Thalassemia, hemoglobinopathy and other hereditary blood diseases. Characterized by a decrease in the average size of red blood cells to 65 fl.
• Hemolytic anemia associated with increased destruction of blood cells (transfusion of blood incompatible with the patient’s group or rhesus, hereditary forms, disseminated intravascular coagulation syndrome).

Important information: What are monocytes in the blood and a table of norms by age of women

When the MCV value in the blood is below normal, but no pathologies are detected, the cause may be conditions associated with blood loss in large quantities:

• surgical intervention;
• trauma with injury to soft tissues and blood vessels;
• donation

Often, a decrease in the volume of red blood cells is also caused by metabolic disorders or endocrinological disorders (increased thyroid function, etc.). These conditions are distinguished from anemia by the normal hemoglobin content. Only a doctor can correctly decipher a blood test and determine the presence of any abnormality.

If you find a reduced reading of the average volume of red blood cells, it is recommended to visit a physician, especially if you have painful symptoms.

MCV below normal

Tests showing that the volume of red blood cells is below normal also indicates pathology. Experts name a number of reasons that can lead to such results:

• genetic predisposition;
• insufficient amount of water consumed;
• development of various types of anemia;
• lead intoxication;
• the presence of malignant formations, tumors in the body;
• taking medications that affect test results.

In medical circles, a disease in which the level of red blood cells in the body decreases is commonly called microcytic anemia. The peculiarity of the disease is that red blood cells do not perform their transport function, i.e. they do not deliver oxygen and other useful substances to the body’s cells in the required quantities.

With this pathology, a characteristic clinical picture is observed:

• constant fatigue;
• increased irritability, nervousness;
• decreased concentration and performance;
• absent-mindedness;
• memory impairment.

A decrease in the volume of red blood cells is always observed with various types of blood loss.

Pregnancy and mcv

During pregnancy, due to the body's increased consumption of iron, microcytic anemia can develop. This condition can negatively affect both the health of the unborn child and the well-being of the mother.

Some experts are convinced that mcv indicators are directly related to a person’s psychological state.

Children's blood tests and vaccinations

A clinical blood test in the Russian Federation is included in the standard examination before vaccination. My opinion is that most often it is completely unnecessary if, for example, the child appears healthy and there are no complaints. Nevertheless, the analysis is carried out and the results are often interpreted completely inadequately.

Many laboratories simply forget about the fact that the interpretation of the results of a child’s blood test has its own characteristics. And they simply write analyzes on standard forms, where “norms” are printed in a column next to the analysis results. But children’s indicators cannot be compared with these standards!

About children's hemoglobin standards

How much hassle these forms with “deviations” from the norm cause parents! How many alarming calls and letters fall upon the pediatrician! My colleagues and I are forced every day to dispel the fears of parents who are trying to independently evaluate the results of their children’s tests.

For example, hemoglobin

. In adults, its norm is from 120 to 150 g/l. For children, everything is more complicated. If immediately after birth “normal” hemoglobin is 180–220 g/l, then by 2–3 months of life its level rapidly drops to the lower limit of normal, which starts at 90 g/l. This is the so-called physiological anemia. And since this is the norm, there is no need to treat it.

Features of the analysis

Today, the mcv test is included in the general blood test or can be performed separately from other indicators. To donate blood, the patient must come to the treatment room, where a laboratory technician or nurse will take blood samples from a finger or vein. Blood sampling is carried out in accordance with all sanitary and epidemiological regulations (SanPiN).

The patient is required to comply with the following rules:

• You need to donate blood on an empty stomach (5-12 hours after your last meal);
• at the time of donation, the woman should not be menstruating;
• feeling normal. It is prohibited to take blood samples if the patient is not feeling well, is in a coma or is in cardiac shock.