5. B12 Deficiency Anemia
B12 deficiency anemia is frequently seen in older women, around the ages of 55-60. Common initial complaint is a burning tongue. Often at this time the patient may be labeled as being psychosomatic, because no other symptoms or signs may be present.
As the condition progresses, there will be depapilation, microglossia (small tongue), beefy red tongue, angular cheilitis, circumoral and peripheral tingling numbness, difficulty swallowing (dysphagia), painful swallowing (odynophagia).
When the B12 deficiency is due to pernicious anemia the patient will also have HCl (hydrochloric acid) and intrinsic factor secretion levels in the stomach.
Diagnosis is confirmed by checking the serum B12 levels, doing the Schilling's test and demonstrate a CBC showing an increased MCV and MCH. The Schilling test is performed to evaluate Vitamin B12 absorption.
Intrinsic factor is produced in the stomach and is required for Vitamin B12 absorption. If the intrinsic factor is not made, the body cannot absorb Vitamin B12. Low levels of Vitamin B12 therefore can occur from the lack of intrinsic factor and this can be due to:
Pernicious anemia gastrectomy (partial removal of stomach)
Inadequate absorption due to bowel disease
Bacterial overgrowth in the intestine
Pancreatic insufficiency or certain medications.
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