DEFICIENCY ANEMIA VITAMIN B12 AND FOLATE - understanding, symptom, Cause, diagnosis, Treatment and complication

Understanding Deficiency Anemia Vitamin B12 And Folate

Anemia is a deficiency of vitamin B12 or folate (vitamin B9) is a condition that develops when the body lacks  vitamin B12  or folate. This is what causes the body to produce red blood cells that are not functioning properly. When the intake of foods with vitamin B12 or folate is not enough, or the body or difficulty absorbing vitamin B12 or folate process, then this type of anemia will occur.
The main symptoms of anemia of vitamin B12 or folate deficiency  be tired and exhausted. If you feel tired and worn continuously, you should consult your doctor. Based on the symptoms and results of blood tests, the doctor may give  a diagnosis of anemia .

Vitamin B12 Deficiency Anemia Patients or folate in Indonesia

Vitamin B12 or folate deficiency is rare in young children, even those undergoing strict vegetarian menu could be at risk. Vitamin B12 or folate deficiency is more common in older people with estimates of 1 in 10 people over the age of 75 years.

Anemia type Suffered

There are various kinds of anemia and each has its own causes. On this occasion, the theme discussed focus on anemia caused by lack of vitamin B12 or folate substances in the body.

Vitamin B12 deficiency or folic

To help the body produce red blood cells, it takes cooperation between vitamin B12 and folate. Vitamin B12 is also useful to help keep the nervous system healthy. This includes the brain, nerves and spinal cord. On the other hand, vitamin B9 or folate is also very important for pregnant women. Folate deficiency in pregnant women can increase the risk of congenital abnormalities or defects in an unborn baby.
Vitamin B12 is found in meat, eggs, and dairy products. While the best source of folate contained in green vegetables such as broccoli, Brussels sprouts, and peas.

Ways to treat Deficiency Anemia Vitamin B12 and Folate

Anemia is a deficiency of vitamin B12 and folic acid most easily overcome. Treatment of anemia  of this type, will initially be given vitamin B12 by injection. Depending whether suffered B12 deficiency related to diet or not, you will probably need a supplement tablet between the feeding schedule. Or, it could also regularly perform injections of vitamin B12. This treatment may be needed for life.
To restore the level of folic acid, folic acid tablets required. The tablet should be taken as long as four months to reach normal levels in the body. Vitamin B12 or folate deficiency with or without anemia, can lead to  complications , though rare. For example, problems with the heart, lungs, and nervous system and increase the risk of infertility. However, all complications can generally be treated.

Symptoms Of Vitamin B12 Deficiency Anemia And Folate

Symptoms of each type of anemia depends on the basic causes of the condition. For all types of anemia, all of which have some common symptoms are the same, namely:
  • Fatigue
  • Fatigue
  • easy  fainting
  • Weight loss
  • Out of breath or dyspnea
  • Headache
  • Loss of appetite
  • Tinnitus or hearing perception of sounds coming from inside the body and not from outside
  • Irregular heartbeat, especially when exercising.
  • Numbness and tingling in the hands and feet.
  • Insomnia.
  • Difficulty concentrating.

Symptoms of Vitamin B12 Deficiency Anemia

The symptoms below are specifically caused by anemia due to deficiency  of vitamin B12 . Symptoms include:
  • Tongue sore and red or sore tongue
  • Skin color becomes yellowish
  • Thrush  in mouth
  • Tactile feel different or diminished function
  • Reduced ability to feel pain.
  • Visually impaired.
  • Easy to get angry.
  • Changes in how to walk and move.
  • Depression : Feeling sad and lasts longer.
  • Dementia: diminished mental abilities, such as memory problems, comprehension, and judgment.
  • Psychosis: Conditions that affect the mind and change the mindset, feelings, and behaviors.

Folate Deficiency Anemia Symptoms

Folate deficiency symptoms similar to the common symptoms of anemia. But this condition can also cause decreased ability of the sense of touch, for example, reduced or loss of sense of touch and pain. And also the ability of muscle weakness and feeling depressed.

Causes Of Vitamin B12 Deficiency Anemia And Folate

Anemia is a deficiency of  vitamin B12  or folate deficiency can be caused by many things. Among others from the diet, genetic disorders, and so forth. Lack of vitamin B12 or folate affects the body's ability to produce red blood cells healthy and functioning properly to carry oxygen throughout the body.
Red blood cells formed large-sized with an abnormal structure, released into the blood stream before the mature red blood cells or so-called megaloblasts its shape. This condition is also called megaloblastic anemia, in which red blood cells can not perform its function because of defects.

Causes of Vitamin B12 Deficiency Anemia

Suffering from pernicious anemia
The body absorb vitamin B12 through the stomach. In order for vitamin B12 is absorbed from the food you eat, a protein called intrinsic factor will attach itself to vitamin B12.
Pernicious anemia is  an autoimmune disease  that affects the stomach. Autoimmune disease means that your body's immune system attacks the healthy cells of your own body. In pernicious anemia, your immune system will attack the cells in the stomach that produce intrinsic factor. As a result, deficiency occurs because the body can not absorb vitamin B12.
There are some things that increase your risk of developing pernicious anemia. Although the underlying cause is not known, the following are some things that can increase the risk of:
  • Affects more women than men.
  • More common in the age above 60 years.
  • Heredity of the immediate family or relatives suffering from the same condition.
  • Having other autoimmune diseases such as Addison's disease and  vitiligo . In fact, there is a link between pernicious anemia with other immune-mediated diseases.

Factors of food consumed

Meat, fish and dairy products is a diet that provides enough vitamin B12 content. Vegetarians or people who only eat foods of plant origin, may not have enough vitamin B12 in their menu. Or people who have a very simple menu in the long term.
Body usually store vitamin B12 which last for two to four years. To keep the vitamin storage remained at a healthy level, it is very important to have vitamin B12 in your diet.
A disease that affects the intestines
When the body can not absorb vitamin B12 as usual, may be caused by diseases that affect the intestines or part of the digestive system. One of them  Crohn's disease . This is a long-term disease that causes inflammation in the walls of the digestive system. This condition can make your body vitamin B12 deficiency.
Conditions that affect the stomach
Obstruction of the process of absorption of vitamin B12 can be caused by conditions of the stomach or gastric surgery. For example, the risk of vitamin B12 deficiency anemia gets increased due to gastrectomy or a surgical procedure in which a portion of the stomach is removed.
Due to the consumption of certain drugs
Vitamin B12 can be reduced from the body due to the consumption of some types of drugs. For example,  proton pump inhibitors  (PPIs), a drug used to treat digestive problems, can make vitamin B12 deficiency worsens. Drugs PPIs prevent excessive stomach acid production. Stomach acid is what is needed to release vitamin B12 from the foods you eat. Your doctor can identify if there are medicines that affect your vitamin B12 levels.
Causes of Folate Deficiency Anemia
Folate is a water-soluble vitamin. Therefore, the body can not store folic in the long term. Usually, the body stores of folate enough to last for four months. To ensure the body has enough folic reserves, we should get folate intake from food daily. Folate deficiency anemia can develop due to some of the same reasons as vitamin B12 deficiency anemia. Some of the causes are explained below.
Food consumed
Some people may not get folate in everyday life. Some factors that may be the cause is food that is unhealthy and unbalanced. In addition, they may just change the type or pattern of daily food, for example for reasons to lose weight. People who consume alcohol are also at risk of folate deficiency anemia.
the occurrence of malabsorption
If you suffer from Celiac disease, this condition can affect the digestive system. As a result, the body can not effectively absorb folate.
Excessive urination
For people with heart disease, kidney and liver, might lose folate from the body. This is due to the effects of the disease, which makes you urinate excessively. Some things that can make you excessive urination:
  • Heart failure  congestive, occurs when the heart can not pump enough blood throughout the body
  • Acute liver damage. Often this is caused by too much consumption of alcohol to excess
  • Dialysis (dialysis procedure) Long term: a dialysis machine to filter waste products from the blood
Due to the consumption of certain drugs
Folate is sometimes difficult to be absorbed and the amount can be reduced. This may be caused by the effects of drugs. The doctor will keep an eye on you if it is necessary to do. Your doctor will know what medicines that could affect the level of folate in the body.
Some other causes
Premature babies born before 37 weeks of pregnancy tend to develop folate deficiency anemia because their growing bodies need more vitamin folate than normal pregnancy the baby is born.
Folate deficiency can occur because the body can not meet the needs of vitamins occasionally exceed normal levels. Things that make the body needs folate more:
  • had cancer
  • when pregnant
  • Fight infections or medical conditions that cause inflammation and / or swelling
  • Have a  blood disorder such as sickle cell anemia. This is because of heredity disorder that causes red blood cells to change shape
pregnancy factor
If you are pregnant or planning to become pregnant, it is recommended to drink 0.4 milligrams of folic acid supplements per day. This is done until gestational age of 12 weeks. This will help the baby grow and develop, as well as making sure you and your baby have enough folate in the body.
If pregnancy to certain conditions, the body may need extra folic acid. To prevent anemia does not occur, the doctor will be watching closely. You can buy folic acid tablets directly or request a prescription from a doctor and take it to the pharmacy, large department stores, or health food store. For people with diabetes, you may need folic acid with a higher dose. You should consume as much as 5 milligrams of folic acid per day.

Diagnosis Of Vitamin B12 Deficiency Anemia And Folate

Based on the symptoms experienced and the results of blood tests, the diagnosis of anemia of vitamin B12 or folate deficiency can be ascertained. To measure the various types of blood cells from a sample, blood counts should be done completely. In general, the doctor will examine:
  • Does the size of red blood cells than normal.
  • If the hemoglobin level is too low.
  • How much vitamin B12 in the blood.
  • How much folate in the blood.
To determine the type of anemia that you experience, the test results will show if you are deficient in vitamin B12 or folate.
If suspected of suffering from vitamin B12 deficiency, then the doctor will advise the patient to undergo some additional tests are:
  • Antibody tests. Antibodies in the blood of patients to be examined.
  • Methylmalonic acid test. In this test, the doctor will examine whether there is a methylmalonic acid in the blood of patients.
  • Tests chilling Patients will be asked to swallow a small amount of radioactive vitamin B12. Then the patient's blood will be checked to determine whether the patient's body to absorb vitamin B12.
Additional testing is required to determine the fundamental causes of deficiencies and determine the most appropriate treatment. To understand the cause of anemia, you may be referred to see a specialist.

See a specialist doctor digestive system

You referred to a specialist doctor digestive system if there is a suspicion that your digestive system is unable to absorb nutrients from food properly. If so, the composition of the vitamin B12 or folate in the body has been reduced.

A specialist haematologist

Hematology physician is a specialist in blood diseases. If you are pregnant and anemic vitamin B12 or folate deficiency, then you are advised to see a specialist hematology.
If the nervous system such as brain and spinal cord have been infected, you will be advised to see a specialist hematology. Symptoms that may occur is a change in vision, sense of touch is reduced or changed, as well as the inability to control muscles.

Consultation with a nutritionist

Nutritious diet can be recommended by nutritionists. They are medical professionals who are experts in nutrition. If the diet is not healthy, it can cause vitamin B12 or folate deficiency. To increase the amount of vitamin B12 or folate in the diet, nutritionists can make the diet more appropriate for us.

Treatment Of Vitamin B12 Deficiency Anemia And Folate

Treatment for anemia, vitamin B12 or folate deficiency depends on what the fundamental causes of the condition. In most of the vitamins to the body replacement efforts, can do injections or  tablets of vitamin B12 .

Treating Vitamin B12 Deficiency Anemia

Vitamin B12 injections are given to treat anemia of vitamin B12 deficiency in the form of  hydroxocobalamin . Every day for two weeks during the initial treatment, you'll get a shot until the symptoms have ceased. These injections can be done by a doctor or nurse.
Treatment depends on the cause of vitamin B12 deficiency. Whether related to food or not, after initial treatment above.

Vitamin B12 deficiency anemia related to food

Prescription tablets vitamin B12 given to drink each day after meals. This is done if vitamin B12 deficiency caused by lack of vitamins in the diet. Or maybe you injected  hydrococobalamin  twice a year. For the perpetrators of the vegetarian lifestyle, will find it difficult to get vitamin B12 in food. In this condition, may need to take vitamin B12 tablets lifetime.
For vitamin B12 deficiency because of poor diet in the long term, consumption of vitamin B12 can be stopped if the content in the body to normal and the food menu has been changed.
A good source of vitamin B12 are meat, eggs, salmon, cod fish and dairy products, including milk itself. For vegetarians or vegans, there are substitute products for meat and dairy products. Foods that contain vitamin B12, such as breakfast cereals rich in  iron  and soy products. When shopping for food, check the nutrition table to see how much of the content of vitamin B12.

Vitamin B12 deficiency anemia unrelated to food

For vitamin B12 deficiency that is not caused by poor diet, may need medication injections  of hydroxocobalamin  four times a year to a lifetime. There are other types of vitamin injections called  cyanocobalamin , but people prefer  hydroxocobalamin  because it can last longer in the human body. Cyanocobalamin  is also available in tablet form.
If you require regular injections of vitamin B12,  hydroxocobalamin  can be injected once every three months, whereas  cyanocobalamin  should be given once a month.
Blood specialist doctors can be recommended as a treatment step when vitamin B12 deficiency can cause symptoms of neurological disease. For example, the feet and hands often feel numb or tingling. You may also need vitamin B12 injections every two months. The specialist will recommend how long you need to injections of vitamins.

Treating Folate Deficiency Anemia

The doctor will prescribe folic acid tablets to increase levels of folate in the body. Folic acid tablets need to be taken for four months. But you can also consume folic acid tablets for much longer, even a lifetime, if the root causes of folate deficiency anemia persists.
In addition, to increase folate intake, daily food menu you also must be considered. A good source of folate include:
  • brown rice
  • Brussels sprouts
  • Broccoli
  • Asparagus
  • Peas
  • arab beans
Before you start taking folic acid, vitamin B12 levels will be checked within normal limits. This check is necessary because the treatment of folic acid can aggravate the symptoms experienced and disguise the symptoms of vitamin B12 deficiency anemia. The nervous system is affected if vitamin B12 deficiency is not detected and not treated immediately.

Conditions oversee During Treatment

A further blood tests are performed to ensure the treatment is successful. The hemoglobin level will be checked through a blood test if it rises at 10 days after starting treatment. To make sure the treatment was successful, a blood test is then performed 2 months thereafter.
Tests will be performed again at four months after treatment is completed if you are taking folic acid tablets. Except, before symptoms reappear or ineffective treatment. Most people with vitamin B12 or folate deficiency does not need to be monitored continuously. To see if your condition has been recovered or if the doctor feels necessary, it will do a blood test back.

Complications Deficiency Anemia Vitamin B12 And Folate

Complications are rare in most cases of vitamin B12 deficiency anemia or the anemia of folate deficiency, but if you are deficient in vitamin B12 or folate in the long term, complications can occur.

Complications Caused Anemia

No matter what the cause, anemia can lead to complications of the heart and lungs, because the heart is working to pump oxygen into the harder the other organs.
Diseases that can develop in patients with anemia is tachycardia or heart rate over 100 beats per minute. Besides it can also occur  heart failure  or when the heart is not pumping blood around the body properly.

Complications Caused by deficiency of Vitamin B12

Complications that occur below caused due to deficiency  of vitamin B12  with or without anemia.

Troubled with fertility

Sometimes a vitamin B12 deficiency can cause infertility for a while.

Abnormalities in the nervous system

The nervous system such as brain and spinal cord may be affected due to lack of vitamin B12. Vitamin B12 is essential for producing red blood cells, and also for the health of the nervous system. Without proper treatment, complications of vitamin B12 deficiency could become permanent. Vitamin B12 deficiency can lead to other health problems before they become anemic. Here are the things that may be experienced:
  • memory loss
  • Troubled by visions
  • Ataxia: loss of physical coordination, this condition can affect the whole body and can cause difficulty talking or walking
  • Paresthesia: tingling sensation

The emergence of  neural tube defects  ( NTD )

Baby's risk of congenital abnormalities ( NTD ) will increase if when the pregnant mother vitamin B12 deficiency in his body. The growth and development of infants affected by this disorder. Some examples of disorders that occur is  spina bifida  , namely, infant spine improperly formed. Moreover, it could happen anencephaly or baby's brain and cranium improperly formed.

Complications Caused by Deficiency Folate

Complications can be caused by folate deficiency with or without anemia. Most complications are described below.

Troubled with fertility

Just like a vitamin B12 deficiency, fertility can also be affected due to folate deficiency. But the impact could be mitigated by taking vitamin supplements and only temporary.

The emergence of  neural tube defects  ( NTD )

Growth and development of the baby in the womb is also influenced by the lack of folate in the body, as well as vitamin B12 deficiency. Congenital abnormalities will increase the unborn baby, such as spina bifida.

Premature delivery

Folate deficiency during pregnancy can increase the risk of babies will be born prematurely or before entering the 37th week of pregnancy. In addition, it can also affect your baby's development. 

The emergence of cardiovascular disease

According to the study, cardiovascular disease will increase when the body's folate deficiency. Cardiovascular disease is a term describing medical conditions involving blood vessels, heart and how blood circulates throughout the body.

cause cancer

According to the study, some cancers can be associated with folate deficiency. One example is stomach cancer. Cancer growth is not only due to folate deficiency, but has the potential to contribute to cancer growth.


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