The possible causes triggering pernicious anemia are: abuse of anti-ulcer drugs, surgical removal of the ileum or part of the stomach (sites of absorption of vitamin B12), celiac disease, vegetarian diet, H. Pylori infection, insertion of a bypass gastric, Crohn’s disease.
If until recently pernicious anemia was included among the incurable and potentially lethal diseases, it is currently considered a treatable and fortunately not very widespread disease.
The treatment of choice is represented by the administration (generally, via intramuscular injection) of vitamin B12 which, as we have seen, is deficient in patients with pernicious anemia.
Possibly, it is possible to complete the therapy with the supplementation of iron supplements.
Below are the classes of drugs most used in therapy against pernicious anemia, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the patient’s state of health and his response to the treatment:
Vitamin B12 supplementation: essential to guarantee survival and elimination of symptoms in patients suffering from pernicious anemia:
- Cyanocobalamin (e.g. Tonocian, Disepavit, Epargriseovit): represents the drug of first choice for the treatment of pernicious anemia. Parenterally, begin administration of the drug at a dose of 100 mcg, intramuscularly, to be taken once a day for a week; in case of a positive response, continue taking the drug every 2 days (for 7 days); subsequently administer the active ingredient every 3-4 days for another 2-3 weeks. In general, most patients with pernicious anemia require monthly administration of the drug at a dose of 100-1,000 mg intramuscularly for life. Alternatively, you can take cyanocobalamin in the form of a nasal spray or nasal gel (500 mcg in one nostril, once a week), only when pernicious anemia does not involve the nervous system.
- Cobamide (e.g. Cobaforte): indicated for the treatment of pathologies characterized by a vitamin B12 deficiency, including pernicious anemia. The drug is an enzymatic form of vitamin B12 which, protected by intrinsic factor, is subsequently absorbed in the duodenum. Available as 2.5 mg capsules, it is recommended to take 2 capsules per day. The drug can also be administered intramuscularly when vitamin B12 deficiency is particularly severe.
Iron supplementation: sometimes, the patient suffering from pernicious anemia may also need iron salt supplementation:
- Ferrous sulphate (e.g. Ferrograd): anti-anemic par excellence, ferrous sulphate is widely used in martial therapy (iron deficiency anemia). Typically, the drug is available in the form of controlled-release tablets with 595 mg of active ingredient. It is recommended to take 1 tablet per day, with water. The drug requires a medical prescription. To improve absorption, it is recommended to take the drug with vitamin C (e.g. with a glass of orange juice).
- Iron fumarate (e.g. Organic Iron): start therapy for iron deficiency anemia with 325 mg of the drug orally, once a day. Continue with maintenance therapy by taking 325 mg of active ingredient, three times a day. The dosage for the treatment of iron deficiency anemia associated with kidney disease remains the same, and it is recommended that the patient be subjected to regular checks.
For further information: see article on drugs for the treatment of iron deficiency anemia
Vitamin C and folic acid supplementation: ascorbic acid and vitamin B9 can also help reduce the symptoms that accompany iron deficiency anemia.
- Folic acid (e.g. Folina, Fertifol, Folidex): available both as soft capsules of 5 mg of active ingredient (to be taken 1-3 times a day), and as an injectable solution of 15 mg of folic acid (to be taken once a day , intramuscularly).
- Vitamin C (e.g. Redoxon, Cebion, Cimille, Univit, C Tard, Agruvit, Univit, Duo C): indicatively, take 50-180 mg of vitamin C per day, orally, intramuscularly or intravenously. Do not exceed 180 mg of ascorbic acid per day.
It should be remembered, however, that the administration of vitamin C and folic acid alone, in the absence of vitamin B12, is not sufficient to cure pernicious anemia.