Vegetarians And Vegans Are At Risk
Vitamin B12 occurs naturally in animal products. So if your diet largely consists of plant-based foods such as fruits, veggies, beans, and soy, you’re at risk for deficiency. “Vegetarians who consume eggs and dairy should aim to include at least one source a day from both of these food groups,” Stephanie Middleberg, RD, nutritionist at Middleberg Nutrition in New York City, tells Health. Veganswho by definition consume no animal productsneed to take a supplement or consume vitamin B12fortified foods, such as breakfast cereal and grains. Other foods fortified with B12 include nondairy milks and meat substitutes. But not all of these foods are fortified, so check the label first to make sure.
How Does Vitamin B12 Help In The Formation Of Red Blood Cells
Vitamin B-12 enables the release of energy by helping the human body absorb folic acid. The human body produces millions of red blood cells every minute. These cells cannot multiply properly without vitamin B-12. The production of red blood cells reduces if vitamin B-12 levels are too low.
When To See A Doctor
You should see a doctor if you experience any symptoms of anemia. Sometimes anemia is caused by medical problems that can become more serious and less treatable if they progress without treatment .
Often, anemia is related to issues such as diet or gastrointestinal problems that prevent proper absorption of nutrients. You can get treatment for your anemia, and you can also get effective treatment for the underlying problem.
And because the symptoms of anemia are nonspecific, its possible that your doctor may diagnose another health problem as the cause of your symptoms.
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Symptoms Of Vitamin B12 Deficiency
Vitamin B12 has very specific and very important functions. A prolonged deficiency will result in a slow deterioration characterized by the following symptoms:
- Weakened reflexes
- A smooth tongue
- Dementia or psychosis
If treated quickly enough, the symptoms of vitamin B12 deficiency can often be resolved. However, if left unaddressed for six months or more, there is a higher likelihood that the nerve damage will become permanent. If pernicious anemia is the cause of the deficiency, then leaving it untreated can become fatal.
How Is Vitamin B12deficiency Anemia Treated
If your doctor diagnoses you with vitamin B12deficiency anemia, your treatment will depend on the cause and seriousness of your condition. Some people need lifelong treatment.
Different therapies can be used to treat anemia.
- Vitamin B12 medicine can be prescribed by your provider for you to take by mouth or as a nose spray or a shot. These supplements can help increase the levels of vitamin B12 in your body. For serious vitamin B12deficiency anemia, your doctor may recommend vitamin B12 shots until your levels are healthy.
- Blood transfusions to treat serious vitamin B12deficiency anemia in combination with vitamin B12 treatment.
Your care provider may also recommend you make some changes to your eating habits to help increase the amount of vitamin B12 in your diet.
Some symptoms may take months to improve, depending on how serious they are. Some symptoms related to the brain or the nerves, such as numbness and tingling, may not go away even with treatment.
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Immune Cells And Organs
Cells of immune system are formed from pluripotent hematopoietic stem cells, capable of self-renewal and differentiation into lymphoid and myeloid progenitor cells. Lymphoid progenitors differentiate into T cells, B cells, and natural killer cells. Myeloid progenitors differentiate into monocytes and macrophage, granulocytes , and other cell types.
In the primary lymphoid tissues , lymphocytes develop and mature to a stage at which they are able to respond to a pathogen. T and B lymphocytes both originate from lymphoid precursors in the bone morrow, but whereas B cells complete their maturation in the bone marrow, before entering the circulation, T cells leave the bone marrow at an immature stage and migrate to the thymus where they mature .
In the secondary lymphoid tissue , mature lymphocytes become stimulated to respond to invading pathogens . The main function of lymph nodes is to trap antigens that flow into them via afferent lymphatic and to provide place for clonal expansion of lymphocytes. The spleen is the lymphoid organ that serves as filter for the blood to remove damaged or senescent red cells and protect against blood-borne pathogens. Splenic macrophages and dendritic cells grab the microorganisms and microbial products in the blood and then stimulate the T and B cells that arrive in the spleen from the blood. The thymus is an organ that lies behind the breast bone and where the T lymphocytes mature.
A Puzzle Of Hemolytic Anemia Iron And Vitamin B12 Deficiencies In A 52
Suartcha Prueksaritanond
1Saint Joseph Hospital, Department of Internal Medicine, University of Illinois at Chicago, 2900 N., Lake Shore, Chicago, IL 60657, USA
Abstract
A 52-year-old male with no significant past medical history reports increasing generalized fatigue and weakness for the past 2 weeks. Physical examination reveals jaundice and pallor without organomegaly or lymphadenopathy. His hemoglobin was 5.9g/dL with a mean corpuscular volume of 87.1fL and elevated red blood cell distribution width of 30.7%. His liver function test was normal except for elevated total bilirubin of 3.7mg/dL. Serum LDH was 701IU/L, and serum haptoglobin was undetectable. Further investigation revealed serum vitamin B12 of < 30pg/mL with elevated methylmalonic acid and homocysteine level. In addition, serum ferritin and transferrin saturation were low. The patient was diagnosed with hemolytic anemia secondary to vitamin B12 deficiency with concomitant iron deficiency anemia.
1. Introduction
Vitamin B12 deficiency can cause reversible bone marrow failure and demyelinating disease due to its inherent function in erythropoiesis and myelination of the central nervous system . Any conditions that cause malabsorption of vitamin B12 as well as dietary deficiency can lead to cobalamin deficiency. Pernicious anemia is the most common cause of vitamin B12 deficiency . Below we present a case of vitamin B12 deficiency due to nutritional deficiency with coexisting iron deficiency anemia.
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How Do I Take Care Of Myself
If you have pernicious anemia, youll need to take vitamin B12 supplements regularly for the rest of your life. Other causes of B12 deficiency may be helped by increasing the vitamin B12 in your diet. Some foods to consider adding to your diet include:
- Breakfast cereals with added vitamin B12.
- Meats such as beef, liver, poultry and fish.
- Eggs and dairy products .
- Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers.
Innate And Adaptive Immunity
In regard to its function, the immune system is divided into two major components: innate immunity and adaptive immunity.
The innate immune response occurs rapidly and can generate effective mechanisms that start rapidly after the infection. The innate immune system consists of physical barriers such as the skin, chemical and microbiological barriers in the mucous membranes, phagocytic cells, and soluble factors . The cells of the innate immunity are phagocytic cells , cells that release inflammatory mediators and NK cells .
Neutrophils are the first line of defense in the body. They are recruited at the site of infection immediately after the invasion of a foreign antigen.
Monocytes are leucocytes that circulate in the blood and travel to tissues where they mature into macrophages able to engulf dead cells or invading pathogens . After exposition to inflammatory stimuli, macrophages secrete cytokines such as tumor necrosis factor , interleukins , leukotrienes, and prostaglandins. All these molecules increase vascular permeability and recruit inflammatory cells .
Natural killer cells have the morphology of lymphocytes, but they do not bear specific antigen receptors . NK cells are important in the defense against viral infection by killing infected cells and secreting of cytokines that hamper viral replication .
B cells secrete immunoglobulinsthe antigen-specific antibodies responsible for eliminating extracellular bacteria.
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What Tests Should I Request To Confirm My Clinical Dx In Addition What Follow
Direct measurement of B12 levels in serum/plasma and of relevant metabolites are required to confirm a diagnostic suspicion of B12 deficiency. In many cases, final confirmation of the diagnosis requires demonstrating normalization of biochemical markers of B12 deficiency following B12 therapy.
Serum/Plasma B12 Levels
Serum values less than 250-200 ng/L according to the assay may be indicative of B12 deficiency but, in isolation, are not indicative of the presence of true B12 deficiency, which must be demonstrated by the concordance of clinical and laboratory findings. The sensitivity of a reduced B12 is excellent in a patients with megaloblastic anemias but is dramatically reduced in subclinical B12 deficiencies.
B12 deficiency is highly unlikely when B12 values in plasma are greater than 300 pg/ml . Two components are measured with the total serum/plasma B12 assays: one is the so-called active holotranscobalamin , which determines the supply of B12 to the tissues via a rapid exchange, and the other is the B12 bound to haptocorrin , which is considered metabolically not exchangeable. Only 20-30% of plasma B12 is bound to holo-TC II. Thus, low total B12 levels are not automatically associated with tissue B12 deficiency, unless âactiveâ B12 values are also decreased. This is often seen in pregnancy in which the total B12 levels decrease significantly, with most of the changes due to a decrease in the holoHC component.
Metabolic Intermediates Assays
Pernicious Anemia
Vitamin D And Our Immune System
Every stage of the immune response depends on the presence of certain micronutrients, and within the last 15 years, vitamin D has emerged as a central regulator of host defense against infections. Although evidence at this time does not suggest vitamin D will influence WBC count directly, Hossein-nezhad et al. recently showed that vitamin D supplementation in vivo regulated the expression of 291 genes, many of which were related to human health. The affected genes are known to interfere with more than 160 distinct biological pathways involved in apoptosis, immune function, transcriptional regulation, epigenetic modification, response to stress, and cell cycle activity and differentiation.
Furthermore, vitamin D has been found to act locally on the immune system and some immune cells have even been found to synthesize vitamin D on their own. Vitamin D receptors are expressed in several types of immune cells, including monocytes, macrophages, dendritic cells, and activated T cells. Macrophages even produce the 25-hydroxyvitamin D hydroxylase enzyme, allowing for the local conversion of vitamin D to its active form. Vitamin D is clearly important to immune cell function and has been found to contribute to innate and adaptive immunity in several ways.
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Key Points About Vitamin B12 Deficiency Anemia
- With this condition, your body does not have enough healthy red blood cells, due to a lack of vitamin B
- It is one of several types of megaloblastic anemia.
- Without enough red blood cells, your tissues and organs dont get enough oxygen. Without enough oxygen, your body cant work as well.
- Symptoms include weak muscles, numbness, trouble walking, nausea, weight loss, irritability, fatigue, and increased heart rate.
- Treatment may include vitamin B12 supplements. It is also important to eat a well-balanced diet.
How Does Pernicious Anemia Affect My Body
The term pernicious means harmful, and pernicious anemia causes harm to several body systems:
- Digestive system problems that cause nausea, bloating and weight loss.
- Nervous system damage that causes muscle weakness, numbness or tingling in your hands and feet, memory loss and dementia.
- Heart problems that can cause palpitations .
- Weakness and fatigue.
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Normal White Blood Cell Levels
White blood cells range in number from 4,500 to 11,000 per microliter of blood, according to the U.S. National Library of Medicine . If that number falls below 4,500, it’s called leukopenia.
Getting to the root of the issue can help. There are many reasons why your white blood cell count may be lower than normal, says Alan Lichtin, MD, a hematologist at the Cleveland Clinic:
- Inaddition to serious blood and lymph diseases such as lymphoma and leukemia, alow WBC count can be a sign of inflammatory disorders such aslupus, or disorders of the liver or spleen like cirrhosis of the liver.
- Cancer in the bone marrow can impairproduction of white blood cells, while chemotherapy drugs can temporarily lowerthe white blood cell count.
- Many other drugs can lower your whiteblood cell count, including some anti-seizure medications.
People with low WBC may tend to feel fatigued, but “lots of people walk around with low WBC count and show no symptoms,” Dr. Lichtin says.
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Why You Should Be Careful With Vitamin B12 Supplements
Disclaimer: Results are not guaranteed*** and may vary from person to person***.
Vitamin B12 is a remarkably useful little nutrient that serves many important functions in the body. It helps red blood cells form and mature, it is used to make DNA, and helps keep nerves functioning as intended.
However, there are two main problems people can encounter when trying to keep the body stocked with this essential nutrient:
1. Your body does not produce vitamin B12 it has to come from a diet.
2. B12 is not retained by the body, since it is water-soluble and not fat-soluble. Any B12 not used is lost through urination.
These two factors combine to create a situation where it is relatively easy to experience a vitamin B12 deficiency.
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Ways To Increase Wbcs During Chemotherapy
Ensuring youre eating a healthy diet with enough protein, vitamin B12, and folate is essential, so talk to your doctor or another medical professional on your care team about referring you to a dietitian.
The dietitian can discuss your diet and how to improve it to boost your immunity by eating enough calories, protein, and vitamin-rich foods. Still, theres no one thing you can eat or avoid eating to improve your white blood cell counts.
You should not start a supplement or vitamin without checking with your doctor or dietitian. Some vitamins and minerals can interfere with your treatment and make chemotherapy less effective.
Who Is At Risk For Vitamin B12 Deficiency Anemia
Risk factors for vitamin B12 deficiency anemia include:
- A family history of the disease
- Having part or all of your stomach or intestine removed
- Autoimmune diseases, including type 1 diabetes
- Crohn’s disease
- Smooth and tender tongue
- Fast heart rate
The symptoms of megaloblastic anemia may look like other blood conditions or health problems. Always see your healthcare provider for a diagnosis.
It’s Hard To Overdo Vitamin B12
Unlike fat-soluble vitamins that accumulate in your body and can have side effects in excess, B12 is a water-soluble vitamin, meaning your body only absorbs a small amount and the rest is excreted through urine, says Middleberg. That’s good news if you need to refill your stores of this nutrient but worry about taking too much. But keep in mind that large amounts of B12 at one time may cause diarrhea and all-over itchiness, she adds. If your doctor recommends supplements, read the label and take only the amount recommended by your MD.
Causes Of A Vitamin B12 Or Folate Deficiency
There are a number of problems that can lead to a vitamin B12 or folate deficiency.
These include:
- pernicious anaemia where your immune system attacks healthy cells in your stomach, preventing your body absorbing vitamin B12 from the food you eat this is the most common cause of vitamin B12 deficiency in the UK
- a lack of these vitamins in your diet this is uncommon, but can happen if you have a vegan diet and do not take vitamin B12 supplements or eat foods fortified with vitamin B12 , follow a fad diet or have a generally poor diet for a long time
- medicine certain medicines, including anticonvulsants and proton pump inhibitors , can affect how much of these vitamins your body absorbs
Both vitamin B12 deficiency and folate deficiency are more common in older people, affecting around 1 in 10 people aged 75 or over and 1 in 20 people aged 65 to 74.
What Is Normal Level Of Vitamin B12 In Elderly
A serum vitamin B12 level between 200 pg/mL and 900 pg/mL is considered normal, but a threshold of 300 to 350 pg/mL is recognized as a marker for a desirable status in the elderly. The laboratory diagnosis is usually based on low serum vitamin B12 levels or elevated serum methylmalonic acid and homocysteine levels.
When Should You See A Doctor
Signs and symptoms of thrombocytopenia may include:
- Prolonged bleeding from a cut or wound
- Easy bruising
- Red dots on the skin that do not blanch with pressure or large areas that similarly don’t blanch
- Bleeding from the gums when brushing teeth
- Heavy menstrual periods
If these symptoms persist, seek medical help right away.
What Questions Should I Ask My Doctor
Pernicious anemia symptoms can take years to surface. You may be surprised to learn you have a condition that can cause serious medical problems. Here are some questions you may want to ask your healthcare provider:
- Why did I develop pernicious anemia?
- How significant is my vitamin B12 deficiency?
- Will treatment prevent more serious medical conditions?
- Are there any side effects to receiving significant amounts of vitamin B12 supplements?
- Will changing my diet help?
- I follow a vegan/vegetarian diet. Can I still eat as I choose?