February 23rd, 2010
People can live with anemia for years before being diagnosed and consequently receiving treatment. If bodyworkers can recognize a potential case of pernicious anemia, a swift referral can prompt an evaluation – and potentially get clients the help they need.
by Nicole Cutler, L.Ac.
Despite its ominous sounding name, pernicious anemia simply describes a type of blood deficiency. A condition where a lack of vitamin B12 does not make enough healthy red blood cells, pernicious anemia is commonly found in those who have lost the ability to absorb vitamin B12 from their food. Unfortunately, many people suffer from pernicious anemia’s consequences for a long time before the cause is identified. Although this condition must be diagnosed by a physician, recognizing a potential case and suggesting an appropriate referral could make a big difference in your client’s quality of life.
Pernicious Anemia Basics
The pathological condition of having insufficient, healthy red blood cells to oxygenate the blood is called anemia. One of the many different types of anemia, pernicious anemia’s lack of vitamin B12 results in blood cells that do not divide normally. Consequently, the blood cells are too large, prohibiting them from leaving the bone marrow to enter blood circulation.
People can develop low levels of this important vitamin in three main ways:
- Intrinsic Factor – Some people lack intrinsic factor, a protein in the stomach that helps the body absorb vitamin B12. The parietal cells that make intrinsic factor can be destroyed by a damaged stomach lining, a destructive immune system or as a result of stomach surgery. Without these cells, intrinsic factor is not manufactured, so vitamin B12 cannot be absorbed. This is the most common cause of vitamin B12 deficiency.
- Dietary Deficiency – Although not a common cause, those with insufficient vitamin B12 in their diet are prone to pernicious anemia. A shortage of this vitamin can be due to strict vegetarianism or malnutrition. The best sources of vitamin B12 are meat, poultry, fish, eggs or dairy products.
- Gastrointestinal Disorders – There are certain intestinal disorders that can interfere with the absorption of vitamin B12, such as Crohn’s disease, intestinal infections or peptic ulcers.
Before the cause was discovered as a lack of vitamin B12, pernicious anemia was often fatal – thus it’s injurious name. It is especially common in older adults and can usually be treated with the administration of vitamin B12 pills or injections.
Signs and Symptoms
As is the case with most types of blood deficiencies, symptoms typically develop slowly over time and may involve just a few of the long list of potential problems. Although many factors contribute to symptom differentiation, the most common signs of pernicious anemia include:
- Having a bright red, smooth tongue
- Tingling and numbness in the extremities
- Pale or yellowish skin
- Low-grade fever
- Orthostatic hypertension (dizziness upon standing up)
In addition to pernicious anemia’s general symptoms, there are also complications that may involve the cardiovascular, nervous and digestive systems. While some of these complications are due to the anemia, others are the effect of a low vitamin B12 level on parts of the body. Not surprisingly, these complications are laden with their own set of symptoms, including:
- Cardiovascular System – Symptoms may include shortness of breath, chest pain, heart murmurs, rapid heart rate and heart failure.
- Nervous System – Hand and feet tingling/numbness, walking difficulty, unsteady movement, loss of balance, changes in vision, taste or smell, memory loss, confusion, depression and psychosis.
- Digestive System – Mouth sores, bleeding gums, enlarged liver, nausea, vomiting, bloating, gas, heartburn, bowel habit changes, loss of appetite or weight loss.
Aside from a referral for a suspected case of pernicious anemia, massage therapy is unlikely to have a direct effect on the condition. However, techniques to keep the digestive system functioning optimally may prevent further stomach-lining deterioration. In addition to being safe, bodywork approaches geared towards enhancing circulation in the stomach and intestines foster a healthy gastrointestinal environment. Such techniques are likely to include:
- Abdominal massage
- Stimulation of stomach and intestine reflexology points
- Shiatsu techniques to invigorate the stomach, large intestine and small intestine meridians
For those with established pernicious anemia, injections of vitamin B12 are a likely treatment, since they may be unable to absorb it orally. For massage therapists administering treatment to a client who receives these monthly injections, the injection site should be avoided for at least one hour following administration. Since vitamin B12 is considered to be replacement therapy, its action is not affected by the application of massage.
A growing number of Americans seek minor body discomfort relief from alternative healthcare providers, such as massage therapists. Thus, massage therapists may be one of the first educated professionals to recognize their client’s need for an anemia evaluation. If a client presents with signs of a vitamin B12 deficiency, yet is unable to determine the source of their ailments, a physician referral to rule out pernicious anemia may be the best advice your client could ever receive.
Wible, Jean M., Pharmacology for Massage Therapy, Lippincott, Williams and Wilkins, 2004.
www.nhlbi.nih.gov, What is Pernicious Anemia?, National Heart Lung and Blood Institute, National Institutes of Health, 2008.
www.medicinenet.com, Pernicious Anemia, MedicineNet, Inc., 2008.
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