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Vitamin deficiency anemia

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HEART & BLOOD

Anemia

 

Risk factors

Do you fall into a risk category for a vitamin deficiency anemia?

  • Folate deficiency anemia. You're at risk of folate deficiency anemia if you're pregnant and you aren't taking a multivitamin containing folic acid. People with intestinal problems that interfere with absorption of folate also are at risk. If you abuse alcohol, your risk is high because alcohol interferes with the absorption of folate. Certain prescription medications, such as some antiseizure drugs, can block absorption of folate. Their use puts you at risk of anemia. If you're undergoing hemodialysis for kidney disease, ask your doctor whether you need supplemental folic acid to prevent a deficiency. Smoking can lead to folate deficiency because it decreases the absorption of folate. If your diet is greatly lacking in fresh fruits and vegetables, or you consistently overcook your food, you also may be at risk of this condition.

  • Vitamin B-12 deficiency anemia (pernicious anemia). You may be at risk of vitamin B-12 deficiency anemia if you don't eat meat and dairy products — foods that contain a lot of vitamin B-12. Strict vegetarians may fall into this category. If you have an intestinal disease, abnormal bacterial growth in your stomach, or surgery to your intestines or stomach that interferes with the absorption of vitamin B-12, you're at risk. However, most people with a diagnosis of vitamin B-12 deficiency anemia lack intrinsic factor — a protein secreted by the stomach necessary for the absorption of vitamin B-12. Lack of intrinsic factor may be due to an autoimmune reaction or a genetic defect. The problem usually develops later in life and is more common in people of Scandinavian and Northern European descent. People with endocrine-related autoimmune disorders, such as diabetes or thyroid disease, also may be at greater risk of developing pernicious anemia.

  • Vitamin C deficiency anemia. Anyone who is malnourished is at risk of this and other vitamin-related anemias. Some conditions, such as hyperthyroidism, AIDS or cancer, can drain the body of vitamin C and lead to a deficiency.

Screening and diagnosis

Doctors diagnose vitamin deficiency anemias through blood tests.

These include tests that measure the level and appearance of red blood cells. In anemia, you have fewer red blood cells. In vitamin deficiency anemias, the red blood cells that you do have are large and underdeveloped. In advanced deficiencies, white blood cells and platelets also look abnormal under a microscope.

Blood tests also include a check of the amount of folate, vitamin B-12 and vitamin C in your blood. Folate and vitamin B-12 levels are measured at the same time because these deficiencies often coexist.

If blood tests reveal a vitamin deficiency, your doctor may perform other tests to determine the type and cause. Diagnosing vitamin B-12 deficiency in particular may involve more tests, such as:

  • Antibodies test. Your doctor may draw a sample of your blood to check for antibodies to intrinsic factor. In the majority of cases, vitamin B-12 deficiency is due to a lack of intrinsic factor — a protein secreted by the stomach necessary for the absorption of vitamin B-12. The presence of antibodies to intrinsic factor indicates pernicious anemia.

  • Methylmalonic acid test. You may undergo a blood and urine test to measure the presence of a substance called methylmalonic acid. The level of this substance is higher in people with vitamin B-12 deficiency.

  • Schilling test. In this test, you first ingest a tiny amount of radioactive vitamin B-12. Then your blood is checked to see if your body absorbed the vitamin B-12. After that, you ingest a combination of radioactive vitamin B-12 and intrinsic factor. If the radioactive B-12 is absorbed only when taken with intrinsic factor, it confirms you lack the substance. If your body doesn't absorb vitamin B-12 with or without intrinsic factor, you likely have a more general absorption problem.

To diagnose vitamin deficiency anemias, your doctor may also take a sample of your bone marrow. Using a needle, your doctor removes a sample of bone marrow from your hipbone. The sample is examined under a microscope to rule out other blood disorders with similar signs and symptoms.

Vitamin deficiency anemia > 1 > 2 > 3 > 4

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