Dealing with Megaloblastic Anemia

A family member of mine was just diagnosed. They’re about 60, extremely thin, and dealing with constant vomiting. I’m no doctor, but this is all pretty foreign territory to me. Has anyone here dealt with this before? What does the treatment look like, if there even is one? Also, any advice on nutrition? We’re looking at a weight loss of nearly 45 pounds. 😕

http://www.nlm.nih.gov/medlineplus/e...cle/000567.htm

I figured you probably already stumbled onto this one, banderas, but I wanted to drop it here for anyone else who might be totally in the dark about this condition... just so they can learn a bit more...

I don't really have any solid advice to give, but looking at what the site says, it seems like it's mostly tied to a B12 deficiency. I'm thinking maybe taking a B-complex supplement regularly could help—especially since there's some weight loss involved too...

Sorry I couldn't be more helpful...

http://www.umm.edu/blood/aneper.htm

found another page if anyone's interested...

Jose Miller3 said:http://www.nlm.nih.gov/medlineplus/e...cle/000567.htm

I figured you probably already stumbled onto this, banderas, but just in case anyone else here hasn't heard of this condition... might be worth a look...

Not really offering much advice here, but looking at the info on that page, it seems like it mostly boils down to a B12 deficiency. I'd guess taking a B-complex regularly might help, especially since there's some weight loss involved too...

Sorry if I'm not being more helpful...

Actually, that wouldn't work. With megaloblastic—or pernicious—anemia, the whole issue is that you're missing the intrinsic factor in the stomach that actually lets your body absorb the B12. That’s why you have to get it via injections...

If it's megaloblastic anemia caused by something else, like part of a more serious underlying illness, then you really have to treat the primary disease first...

I didn't say "drinking," I meant more like "controlled consumption"... 😉

No other underlying medical issues have been diagnosed. What should I be eating to put on some weight—I'm talking maybe 20 pounds—without completely wrecking my stomach along the way? 😁
Regarding B vitamins, B12 tablets are causing me major issues right now. Does anyone know if there's a B complex available that doesn't include B12? 😁

Spot on. Basically, when you're missing that stomach transport protein—I think they call it "intrinsic factor"—to carry B12, you end up with pernicious anemia. It’s a real bummer because even if you load up on all the B12-rich foods you want, your body just can't absorb any of it. You're stuck needing those B12 injections to actually get the nutrients where they need to go.
Unfortunately, once you finish that initial treatment phase, you're usually looking at a lifetime of B12 shots. I'm talking something like a 500mcg dose once a month, just to stay level.
Another thing that's super important is that people dealing with this really ought to get a gastroscopy done at least once a year. There's been some data suggesting that folks with this condition have a higher risk of developing stomach cancer—honestly, who knows why that happens, but it's definitely something to keep an eye on.

Look at it from my perspective... If we’re talking about primary pernicious anemia, then honestly, you guys can all go ahead and pop the champagne. Dealing with any of those other possibilities that fit this specific clinical picture would be way, way more of a headache.

Yeah, I’m aware of the alternative options, but they aren't even on the table right now. 😬
For the time being, they're sticking to one 1000 microgram injection per week.
The patient actually survived botulism back when they were younger. I'm looking at a generic list of B-complex tablets here, and it shows 1 microgram of cyanocobalamin. That's B12, right? If it is, then those specific tablets should probably be avoided entirely, shouldn't they? 😕
What’s the actual distinction between pernicious and megaloblastic anemia? In this case, the diagnosis is megaloblastic. Also, any tips on how to manage or cut down on the vomiting?

banderas said:Any tips on how to stop or cut down on the vomiting?

Zofran? 🤔

I mean, it should definitely help, right?

And as for gaining weight... honestly, it’s going to be tough to get back to a normal weight if their metabolism isn't actually kicking into gear. And you really can't get that working properly without B12. How long have they been doing those injections?

banderas said:So, what’s actually the difference between pernicious and megaloblastic anemia?

I guess you aren't really one for clicking the links people drop for you, huh? 😉

What is megaloblastic (pernicious) anemia?
Megaloblastic (pernicious) anemia is this rare condition where your body just can't soak up enough vitamin B12 through the digestive system... which ends up leaving you with way too few red blood cells.

You’d be better off just admitting they're the same thing instead of pulling these random quotes out of thin air 😁

EDIT: Actually, scratch that—they aren't the same. Check out the first link 😕

Jose Miller3 said:Zofran? 🤔

I mean, it should help, right?

As for the weight gain issue—it’s going to be a struggle to get back to a normal weight if the metabolism isn't firing on all cylinders. And you can't expect that to happen without B12. How long has she been on those injections?

She’s been on them for two years now; the diagnosis wasn't exactly a recent surprise, just that the "person" in question acts a bit off. 😬Is there such a thing as a B complex without B12 in pill form? And is oral B12 something to avoid at this point?

banderas said:Is there such a thing as a B complex without B12 in pill form?

I doubt it... I mean, cyanocobalamin is pretty much one of those essential things you just have to get from food, so I'm guessing most B complexes will just include it by default.

Actually, most of the time people take a B complex anyway just to make up for a B12 deficiency—whether that comes from their diet or whatever else...

From what I gather, taking B12 orally just doesn't really get absorbed properly anyway, so it shouldn't be causing any real issues... I'm not sure if they even make a B-complex without the B12 included, but you can definitely find B1 or B6 on its own in pill form. I think those used to be around a few years back, too...

They aren't the same thing. Pernicious anemia is caused by a lack of an internal factor necessary for absorbing vitamin B12, whereas megaloblastic anemia is just a general term for anemia caused by a deficiency in that same vitamin—which could stem from diet (like being vegetarian), pregnancy, or breastfeeding (increased demand), etc. In this specific scenario, I’d lean toward it being pernicious if the person eats a standard diet (meat, organ meats, legumes, dairy...). Nutritional megaloblastic anemia usually doesn't show up until someone has been eating poorly for four or five years.

Taking vitamin B12 orally won't hurt you in this case, but it's not going to do much since it isn't being absorbed; injections are mandatory. I'm just wondering if this kind of therapy has to be lifelong, since I was actually diagnosed with the exact same thing just a few days ago.

Pernicious anemia basically kicks off when the body’s internal security system—its autotolerance mechanisms meant to protect our own tissues, cells, and biomolecules—just stops doing its job. When the immune system bumps into its own antigens, things usually go one of three ways (hopefully the good kind):

1. Apoptosis, which is just fancy talk for programmed cell death
2. Anergy, where the cells basically go into a functional coma
3. The creation of autoregulatory cells

In those three scenarios, there's no "second signal" to tell the system that this contact is actually a threat. But when autotolerance fails, that second signal can suddenly be provided. It's been documented that microorganisms can actually trigger the expression of costimulators. Basically, a microbe can mimic an autoantigen and simultaneously kickstart that costimulator expression, providing both signals needed to launch an attack.

Think of pernicious anemia as a case of the immune system being way too sensitive—it's an overkill response. We're talking Type II hypersensitivity here, meaning it's driven by autoantibodies. These antibodies go after the parietal cells and/or the intrinsic factor tucked away in the stomach lining:



Those parietal cells are responsible for pumping out the intrinsic factor, which is absolutely vital for absorbing Vitamin B12 down in the terminal ileum.

What you'll see in the lab work:

A massive drop in red blood cell mass, megaloblastosis, megalocytosis, hyperchromia, poikilocytosis, along with leukopenia and some moderate thrombocytopenia.

The specific markers: Vitamin B12 excretion stays totally normal during the first stage of a Schilling test, only showing up in the second stage once you add back the intrinsic factor; low serum B12 levels; elevated methylmalonic acid in the urine; and high serum LDH-1 levels, which happens because the body is frantically breaking down megaloblasts loaded with lactate dehydrogenase in the bone marrow (what doctors call ineffective erythropoiesis). You also see a positive response to parenteral B12 therapy, which typically triggers a huge reticulocyte crisis around day eight (that's our first follow-up) after starting 2g of B12 daily; a complete lack of HCl in gastric juice even after histamine stimulation; and finally, high titers of antibodies against intrinsic factor and parietal cells. Usually, you'll hit full remission between weeks five and eight of therapeutic B12 dosing (our second follow-up).

What if that guy actually has what they call SPACER?
I'm leaning towards yes...
Cheers!