Pernicious Anaemia Society
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Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include the following:

Complete blood count (CBC)—a count of the number of red and white blood cells in a blood sample

Vitamin B12 level—a test that measures the amount of vitamin B12 in the blood

Methylmalonic acid (MMA) level—a measurement of the amount of methylmalonic acid in the blood; this test determines whether a vitamin B12 deficiency exists.

Homocysteine level—a test that measures the amount of homocysteine in the blood (homocysteine is a building block of protein). The homocysteine level will be elevated if there is a shortage of vitamin B12, folate, or vitamin B-6.

Schilling test—a test in which a harmless amount of radiation is used to assess whether a vitamin B12 deficiency exists (rarely used)

Red blood cell folate level—a measurement of the amount of a B vitamin called folate

Gastrin level—a test that may help determine the cause of a vitamin B12 deficiency

Intrinsic factor assay—a measurement of the amount of a protein called intrinsic factor normally produced in the stomach; this test helps to rule out pernicious anemia as the cause of symptoms.

Bone marrow staining—a test that shows whether an iron deficiency exists


Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Oral Vitamin B12 Supplement

This treatment consists of high doses of an oral vitamin B12 supplement.

Vitamin B12 Injections

The doctor may advise the patient to receive injections of vitamin B12 into a muscle. Injections of vitamin B12 may be given 2-4 days per week. When blood tests show improvement, the doctor may give injections on a monthly basis.

Treatment With Antibiotics: This type of medication may be needed in cases where bacterial overgrowth in the intestines exists. The bacteria compete with the body to absorb the vitamin B12 in the intestines.

Intranasal Vitamin B12: The doctor gives the patient a supplement of vitamin B12 that is placed in the nose.

Oral Iron Therapy: The physician will recommend this treatment when an iron deficiency exists. In this case, the doctor will tell the patient to take iron supplements before treating with vitamin B12.

Prevention: To help reduce your chances of developing a deficiency of vitamin B12, take the following steps:

Avoid long-term over-consumption of alcohol.

As directed by your doctor, take a daily supplement containing vitamin B12.

As directed by your doctor, give vitamin B12 to your breastfed baby if you are a vegan or vegetarian.

Avoid overuse of nitrous oxide.

Seek diagnosis and treatment of any suspected tapeworm infestation.

Have your doctor check you for iron deficiency.

Undergo testing if your doctor suspects you are infected with the bacterium Helicobacter pylori .

Have your doctor monitor your health closely if you are taking the following drugs:

Biguanides, Aminosalicylic acid, Calcium-chelating drugs taken by mouth, Colchicine, Neomycin, Cimetidine, and Cholestyramine

Last reviewed October 2012 by Daus Mahnke, MD


2 Replies

Can't help wondering why Cimetidine is singled out. Surely, if the effect is mediated by the reduced acid production, it would apply to all of the class H2-receptor antagonist?

And, for that matter, proton pump inhibitors?


Yes, not only cimetidine but all proton pump inhibitors as well. When I complained of stomach pain the MD prescribed Omeprazole, and recently through my research I came across that it also blocks the absorption of B12. You can see why I stay away from any pharmaceuticals. My stomach pain was caused by inflammation, whether IBS or Chron's I do not wish to find out. it stopped through change in food intake: first six months of no grains whatsoever, and slowly all symptoms started to go away. Then I came across 'lectins" that many foods have, and eliminated those as well. My current diet is a high protein diet, for I also discovered that blood type B RH POS carry an enzyme in their stomchs that breaks down fat (lipids), so I want to benefit from that and returned to being a meat eater, just the way I was raised, roastbeef every Sunday, steak and kidney pies, tenderloin every week. It is working, I have no bloating, or burning. Oh, I squirt lemon juice over stakes, whether meat or salmon. It provides ther acid necessary to digest. All acidic foods outside the body change to alkaline when inside.



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