Pernicious Anemia (cont.)

The first step is always a thorough history and physical examination by a health care practitioner. The results of this examination are used to help direct further testing. A number of laboratory tests are available that can help diagnose pernicious anemia as well as other causes of vitamin B-12 deficiency. These tests include:

• A complete blood cell count (CBC)
  
  
• Examination of a blood smear (peripheral smear) under a microscope, often performed in association with a CBC
  
  
• Blood vitamin B-12 level measurements
  
  
• Tests for the presence of autoantibodies to intrinsic factor or stomach lining cells
  
  
• Blood levels of iron and iron-binding capacity
  
  
• Folate levels (which are often reduced when vitamin B-12 levels are low)
  
  
• Blood levels of methylmalonic acid or homocysteine, both of which may be sensitive indicators of vitamin B-12 deficiency
  
  
• The Schilling test, a measure of how well the body can absorb vitamin B-12, is less commonly used today than in the past.
  
  
• Finally, bone marrow aspiration or bone marrow biopsy may be recommended in some cases if bone marrow disorders are suspected

The symptoms of pernicious anemia and vitamin B-12 deficiency can be treated by replenishing the vitamin B-12 supply in the body. If a condition other than pernicious anemia is responsible for vitamin B-12 deficiency, treatment must also be directed at the underlying condition. Symptoms of vitamin B-12 deficiency may be improved after just a few days of medical treatment.

Vitamin B-12 is typically given as an intramuscular injection (shot). An injection of 1000 micrograms (1 mg) of vitamin B-12 is generally given every day for one week, followed by 1 mg every week for four weeks and then 1 mg every month thereafter.

Alternative treatments for pernicious anemia include high-dose oral vitamin B-12, since a lower-efficiency absorption system for vitamin B-12 exists in the intestine that does not require the presence of IF. However, the oral dose required for this type of therapy (1 to 2 milligrams/day) is more than 200 times higher than the minimum daily vitamin B-12 requirement for adults and is significantly higher than that available in most standard multivitamins and B-12 supplements. Nasal spray and sublingual (under the tongue) preparations of vitamin B-12 are also available and are under investigation.

Source: MedicineNet.com
http://www.medicinenet.com/pernicious_anemia/article.htm