Pernicious Anemia - Treatment

Treatment

The treatment of PA varies from country to country and from area to area. A permanent cure for PA is lacking, although repletion of B₁₂ should be expected to result in a cessation of anemia-related symptoms, a halt in neurological deterioration, and (in cases where neurological problems are not advanced) neurological recovery and a complete and permanent remission of all symptoms, so long as B₁₂ is supplemented. Repletion of B₁₂ can be accomplished in a variety of ways.

The most accessible and inexpensive method of repletion is through dietary supplementation, in the form of oral or sublingual B₁₂ tablets. B₁₂ supplements are widely available at supermarkets, health food stores, and drug stores, though quality and cost may vary. In some countries, the cobalamin preparation may be available only via prescription. Doctors can prescribe cobalamin tablets that contain doses higher than what is commercially available.

A 2003 study found oral and sublingual B₁₂ were absorbed equally well in a group of patients with very low B₁₂. In this study, 22% of the subjects who agreed to undergo the test (five of 23), had abnormal Schilling tests, but showed no difference in treatment levels from the other subjects. When oral tablets are used to treat PA, higher-than-normal doses may be needed. The efficacy of using high-dose B₁₂ tablets to treat ordinary PA (i.e. anemia due to atrophic gastritis) is well established. Oral supplementation allows B₁₂ to be absorbed in places other than the terminal ileum (where it usually takes place). A 2006 study found oral B₁₂ repletion has the potential to be as effective as injections.

However, if oral or sublingual repletion is inadequate, the patient may require B₁₂ injections, which are usually given once a month, bypassing the need for gastrointestinal absorption altogether. Eventually, the patient may be able to do this at home. Cobalamin (one of the forms of B₁₂) is usually injected into the patient's muscle (intramuscular or IM) using cyanocobalamin (the United States, Canada and most European countries) or hydroxocobalamin (Australia and the U.K.). The injections will typically need to be given for the remainder of the patient's life. The frequency of injections varies by country and health care practitioner, and may be as infrequent as once every three months in some countries. The most common complaint by members of the Pernicious Anaemia Society is patients have different needs, with some patients needing more frequent injections than others. Some medical professionals believe subcutaneous injections are more effective than intramuscular injections, but the evidence for this is currently unclear.

The other methods of administering B₁₂ include nasal sprays and behind-the-ear patches. One small study from 1997, with six participants, found intranasal delivery of B₁₂ led to increases in plasma cobalamin as high as eight times a given patient's baseline measurement. Further investigation of these delivery methods is needed.