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Crohn's Disease Forum » General IBD Discussion » Is pernicious anemia low vitamin B12 or Intrinsic Factor


 
11-03-2011, 10:40 PM   #1
David
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Is pernicious anemia low vitamin B12 or Intrinsic Factor

I'm confused about pernicious anemia. Each source I read confuses me more. Does anyone know if pernicious anemia is specifically:

1. Low intrinsic factor
2. Low vitamin B12
3. Low iron due to the above.
4. Some combination of the above.

Thank you!
11-03-2011, 11:05 PM   #2
kiny
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It's 1 and 2

2 is the consequence of 1

You don't produce enough intrinsic factor, your tummy needs intrinsic to bind with extrinsic, to take up the B12, you don't have it, so you never get the B12.
11-03-2011, 11:17 PM   #3
David
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Now, if I have low B12 because my terminal ileum is inflamed do I have pernicious anemia? Or is that only if I have low B12 because I have low intrinsic factor?
11-03-2011, 11:23 PM   #4
kiny
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From what I understand, the prenicious anemia is a condition of just not having enough intrinsic factor, and then that's associated with X, Y, Z.

For crohn's it's inflammation, on those spots there should be mucosa, but instead it's replaced by what's under it, just intestin, or mast cells when it starts healing, those don't have the ability to bind with the extrinsic factor so you are considered to have prenicious anemia.
11-03-2011, 11:30 PM   #5
kiny
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ok, now people are making me doubt what is considered prenicious anemia and what not

Last edited by kiny; 11-04-2011 at 12:40 AM.
11-04-2011, 12:06 AM   #6
handle
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It is confusing.
Pernicious (meaning harmful or even fatal) anemia is only one type of B-12 deficiency. Pernicious anemia results from the presence of an autoantibody against intrinsic factor (IF), a protein made in the stomach, that is necessary for the absorption of vitamin B-12 further down the intestinal tract.
If you have an inflamed or resected terminal ileum then you may have B-12 deficiency and all the same symptoms of pernicious anemia, but that condition is not called pernicious anemia, since it doesn't involve the lack of I.F.
11-04-2011, 12:19 AM   #7
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Also leading to confusion:
Anemia is a lack of sufficient red blood cells. Iron deficiency anemia (the most common type of anemia) is quite different to B-12 deficiency anemia.
11-04-2011, 12:31 AM   #8
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Pernicious anaemia is the name given to type of anaemia experienced from a lack of intrinsic factor.

Intrinsic factor is a glycoprotein that is excreted by the parietal cells in the mucous membrane of the stomach. The role of intrinsic factor is to absorb B12 from the food you ingest.

If you have intestinal damage from Crohn's in the terminal ileum or have had your terminal ileum resected you still have the ability to absorb B12 from food but you don't have the ability to absorb that B12 from the intestine into the body.

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11-04-2011, 12:39 AM   #9
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Oops, I mean't to add that pernicious anaemia is the common name give to a lack of intrinsic factor but it in fact refers to the type of anaemia caused by a lack of B12 full stop. So whether your lack of B12 is via intrinsic factor, malabsorption or severe dietary restrictions they are all technically pernicious anaemia.

Now have I thoroughly confused you!

Dusty.
11-04-2011, 01:18 AM   #10
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With due respect, the term 'pernicious anemia' is sometimes also incorrectly used to indicate megaloblastic anemia due to any cause of vitamin B12 deficiency, however its proper usage refers to that caused by atrophic gastritis, parietal cell loss, and lack of intrinsic factor only.
11-04-2011, 10:29 AM   #11
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11-04-2011, 11:22 AM   #12
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11-04-2011, 12:58 PM   #13
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@ Jessi... without being techical I have never had low iron, or enemic. I have low b12 because of two resections in the Ileum. If you have Crohns in that area, most likely you are not absorbing it. I had my b12 shot yesterday and I have a bit more energy but I am certainly not running a marathon come to think of it I never run (only on the treadmill) LOL
11-04-2011, 03:01 PM   #14
DustyKat
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With due respect, the term 'pernicious anemia' is sometimes also incorrectly used to indicate megaloblastic anemia due to any cause of vitamin B12 deficiency, however its proper usage refers to that caused by atrophic gastritis, parietal cell loss, and lack of intrinsic factor only.
I will respectfully agree to disagree.

Dusty.
11-04-2011, 09:18 PM   #15
handle
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Bonza mate! (Aussie speak.)
11-04-2011, 09:20 PM   #16
David
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This is the exact issue I've been facing. I know both of you are extremely bright, well read, and know boatloads of medical stuff. I haven't been reading crappy websites that review tacos, washing machines, and IBD but actual medical texts that give me conflicting definitions which I'm guessing is why the two of you disagree.

Tis' frustrating but kinda funny as well
11-09-2011, 09:21 AM   #17
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Classic pernicious anaemia is defined as having intrinsic factor antibodies. However, pernicious anaemia can develop from; having surgery to any part of the digestive tract; from coeliac disease; and/or crohns disease. It can also develop from chronic gastritis. If your body loses the ability to absorb B12 from a natural process then the resulting anaemia does become pernicious. This is often referred to as B12 Malabsorption however the treatment for pernicious anaemia and B12 malabsorption is the same and the end result of not getting treatment for pernicious anaemia and B12 malabsorption is also the same..death.

Regards,
Pat
Canada Delegate Pernicious Anaemia Society
11-09-2011, 09:26 AM   #18
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Hi Pat!

Welcome to the forum and thank you so much for chiming in A couple questions:
If your body loses the ability to absorb B12 from a natural process then the resulting anaemia does become pernicious.
1. Do you have pernicious anemia as soon as your body loses the ability to to absorb B12?

Or

2. Do you have pernicious anemia as soon as you have low B12 because of your lack of ability to absorb B12?

Or

3. Do you have pernicious anemia as soon as your iron levels become low because of your low B12?

Thank you! And again, welcome I hope you become a regular part of our community.
11-09-2011, 09:55 AM   #19
kimks mom
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Hello David,

Thank you for your welcome. Your questions are often asked on our forum and there is no clear answer.

1. Once the body loses the ability to absorb B12 then, in my opinion, pernicious anaemia has developed.

2. You would have to determine first if your low B12 is caused by an inability to absorb B12. For example, some doctors will prescribe cyanocobalamin tablets to swallow when a patient presents with low B12. If you cannot absorb B12 then swallowing cyanocobalamin tablets will not raise your B12 level. However, if your B12 level did raise to a healthy level and this level should be over 500, then this would just be a diet related B12 deficiency. If your B12 level did not raise above 500 then I suspect it would be pernicious anaemia (PA).

3. Iron has nothing to do with PA other then it can co-exist with PA and is quite common in our members. It is also very common for our members to have not only PA but Iron Deficiency Anaemia (IDA) and folate anaemia. In order to have healthy red blood cells, you need a healthy supply of B12, iron and folate. It seems that when you are low in B12, your body will draw from iron and folate to try and make up the loss. Thus you end up with lower levels of iron and folate. This causes a problem for many of our members because most of our doctors don't check folate levels. In order for a B12 injection to be properly utilized it needs a healthy supply of both iron and folate.

My daughter was diagnosed with PA and folate anaemia. To date she has not become deficient in iron but she is monitored yearly for this level as well as B12 and folate.

Regards,
Pat
11-09-2011, 04:06 PM   #20
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Wow!

Very interesting.
11-09-2011, 04:56 PM   #21
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Although I do not have IBD, I was diagnosed years ago with pernicious anemia. My lab work showed high levels of intrinsic factor antibodies. For the rest of my life, I have to give myself a monthly 1cc B12 shot.
11-09-2011, 09:42 PM   #22
David
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Thank you for your detailed response Pat

2. I've read some studies (example abstract) that state high dose oral cyanocobalamin can be absorbed by patients with pernicious anemia and even in those who have had their terminal ileum removed. They seem to feel that approximately 1% of the B12 passively diffuses into the bloodstream from the small intestine. However, the NIH seems to think it is too unreliable. Point being, a rise in B12 from high dose oral supplementation may not necessarily mean diet related deficiency.

3. Do you feel low B12 can lead to iron deficiency anemia? And have you read this by chance?

New:

4. I notice you use "500" as what appears to be your normal level for B12. Would that be correct? If so, what is the "normal" level there in Canada or does your group feel 500 pg/ml is the correct normal? Here in the USA, most doctors will not supplement if you're 200 pg/ml or higher. I've noticed in some countries like Japan, 500 or higher is considered normal which is what I agree with as I continue to read available research.

Thanks
11-09-2011, 10:32 PM   #23
crohnicaly stinky
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Because of this thread I went to find out if I could get testing for vitamin and mineral levels. In fact, you can purchase your own tests with the blood taken at a chain diagnostics company, like labcorp.

Reading the description of the tests is somewhat educational in itself the normal levels are listed and in some cases what symptoms abnormal levels would result in.

Figuring out which test to take is not going to be easy, and I only went looking because I can imagine not being able to convince a doctor to order the tests.

For some vitamins there were more than one test.

Sent from my ADR6350 using Tapatalk
11-09-2011, 10:35 PM   #24
David
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Because of this thread I went to find out if I could get testing for vitamin and mineral levels. In fact, you can purchase your own tests with the blood taken at a chain diagnostics company, like labcorp.
Oooh! This is very interesting to me!

How much? What tests can you get done? What company is this through? Tell me tell me tell me

Oh, and have you read our vitamin and mineral deficiencies thread?
11-09-2011, 10:42 PM   #25
crohnicaly stinky
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Google online blood tests, there will be several results. :-)

I saw that thread. I'm very interested in the topic. Thanks for all the time you have put into it.

Try Direct Labs and click the read more on the folate test. Sound familiar?

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11-09-2011, 11:22 PM   #26
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I just looked at my blood test results from last year and my b12 was tested at 317 pg/mL with a reference range of 180-914. But it says that less than 145 would be deficient. Why is there so much discrepancy over what is considered "normal"?

Scott, that's cool abt getting to pick your blood tests.
11-09-2011, 11:52 PM   #27
DustyKat
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Do you feel low B12 can lead to iron deficiency anemia? And have you read this by chance?

I don't think a B12 deficiency causes Iron deficiency anaemia but I do think with Crohn's they are closely linked and most likely occur together for many people.

Many of the heme iron rich foods aren't tolerated well by many Crohnies, particularly red meat. Add to that the issues of bleeding, whether it be the obvious type or the more insidious microscopic type, and for women, menstruation, then iron deficiency anaemia can easily become a problem.

Just my two cents worth...

Dusty.
11-10-2011, 10:05 AM   #28
kimks mom
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Thank you for your detailed response Pat

2. I've read some studies (example abstract) that state high dose oral cyanocobalamin can be absorbed by patients with pernicious anemia and even in those who have had their terminal ileum removed. They seem to feel that approximately 1% of the B12 passively diffuses into the bloodstream from the small intestine. However, the NIH seems to think it is too unreliable. Point being, a rise in B12 from high dose oral supplementation may not necessarily mean diet related deficiency.

3. Do you feel low B12 can lead to iron deficiency anemia? And have you read this by chance?

New:

4. I notice you use "500" as what appears to be your normal level for B12. Would that be correct? If so, what is the "normal" level there in Canada or does your group feel 500 pg/ml is the correct normal? Here in the USA, most doctors will not supplement if you're 200 pg/ml or higher. I've noticed in some countries like Japan, 500 or higher is considered normal which is what I agree with as I continue to read available research.

Thanks
Hi David,

1. Yes, I have also read the studies about high dose oral cyanocobalamin. I also drafted the PAS policy on oral cyanocobalamin. The studies refer to high dose cyanocobalamin as being effective to treat PA/B12 deficiency. However, the effectiveness is based on PA patients being able to absorb 1 per cent by diffusion. One per cent of a 1,000 mcg oral cobalamin tablet equals 10 mcg. Even if there are 5000 mcg oral cyano tabs, the amount absorbed would only be 50 mcg. For any PA patient who has neurological involvement or SACDSC (sub acute combined degeneration of the spinal cord) the amount absorbed would in no way be able to do any repair to the damaged nerves. We have had members prescribed oral cyanocobalamin prior to a diagnosis of PA. Those members were not able to get their B12 level above 300.

2. I had not read the article on Erythropoiesis but I always suggest to our members they ask their doctor to order a reticuloycte test as a follow up to see if they are responding to treatment. We are well aware of the importance of iron and folate and how it relates to B12. We further stress that when you have a nutritional deficiency such as B12 that you are more susceptible to developing other nutritional deficiencies such as iron or folate. Everyone of our members either have a folate deficiency or an iron deficiency along with the B12 deficiency, some have all three deficienies. PA patients have a similar problem to crohns disease patients. Constant diarrhea is a common symptom. This usually does clear up when the patient gets enough B12 but we have found that folate deficiency makes this symptom worse. When a member mentions they have constant diarrhea, we tell them to get their folate level checked and it usually turns out the member is folate deficient. When you have constant diarrhea you lose a lot of nutrients. I would think the same happens with a crohns patient as a PA patient..as soon as they eat, it goes right through them. This is a topic that I wrote for our forum and ask all new members to read it. It discusses the importance of iron and folate and why it is necessary to take a Vitamin B complex if you are taking B12 injections for a prolonged period of time.

We do use 500 as a cut off level. We know that B12 deficiency can occur in the absence of megaloblastic anaemia as there is quite a bit of research on this. We have chosen to go along with the theory that Japan uses this level as a cut off point but we have never been able to find the actual research article that states this. We have found many articles that allude to this but not the actual paper itself.

The Canadian reference range for B12 is 198 - 615 pmol/L. The PAS disregards the reference range for the following reasons:
They are too low and need to be re-visited. They are based on an outdated RDA established in the 1950's.
The serum B12 test is seriously flawed. In the UK, the PAS is working with Axis Shield link to have the serum B12 test replaced with the active B12 test. The serum B12 test measures all of the cobalamin in the body, both active and inactive. The active B12 test recognizes the difference and measures only the active cobalamin, that which the body can use. For example, you may have a B12 level of 340. Of that level, 300 could be haptocorrin (inactive B12). That means your true B12 level would be 40. This test is just becoming available in the UK and is now being marketed towards the U.S.

To get back to B12 levels, we suggest to our members they should strive for a healthy level of 1000 and over. Many of our members self-inject, including my own daughter and she maintains a B12 level of over 1300. Every one of our members who have chosen to learn how to self-inject, inject when they feel they need the injection and all have improved dramatically.

Regards,
Pat

Last edited by kimks mom; 11-10-2011 at 11:49 AM.
11-10-2011, 10:10 AM   #29
David
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Pat, you are amazing Thank you! I'll digest everything you read and respond more appropriately (hopefully today) but WOW! Thank you so much!
11-10-2011, 11:50 AM   #30
kimks mom
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I edited my post to fix the links...the codes for your forum are a bit different from ours..the links are working now.

~Pat
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