The patient feels well. Once blood values return to normal,
usually just a single injection of vitamin B12 per month suffices for good
health. There is no primary prevention for ordinary pernicious anemia. But
there are other conditions that lead to vitamin B12 deficiency and to an anemia
that resembles the pernicious type. They include destruction or removal of the
stomach, regional ileitis, removal of the ileum (the lower portion of the small
intestine), and fish tapeworm disease. When anemia stems from these conditions,
primary prevention is possible. Fish tapeworm disease can be avoided by eating
only well-cooked fish.
When the stomach or ileum is destroyed or removed,
injections of vitamin B12 can be given regularly to prevent the anemia from
developing. Hemolytic Anemia In this type of anemia, red blood cells are destroyed.
Hemolytic anemia may be congenital or acquired, acute or chronic. In addition
to symptoms common to other anemias such as fatigue and shortness of breath,
hemolytic anemia usually produces some degree of jaundice because the destroyed
red cells release their hemoglobin which is converted into jaundice pigments.
Sometimes an acute form of hemolytic anemia appears suddenly, with chills,
fever, nausea, and vomiting, abdominal pain. The cause may be a medicine to
which the patient is sensitive, bacterial or malarial infection, metastatic
cancer, or Hodgkin's disease.
If the basic cause
can be removed (e.g., an offending medicine) or cured (e.g., malaria), the
outlook is good. Usually the situation calls for prompt hospitalization. In
the, hospital, with injections of fluids, transfusions of packed red cells, and
use of corticosteroid medicines, the patient makes a good recovery. Some
hemolytic anemias are chronic and may last for years. . It occurs in 1 of 1,500 American blacks.
Many patients live to age o and beyond.
When complications occurs, they are apt
to be infarctions III blood vessels of lungs or spleen, bleeding from the
kidney, or eye probe retinal detachment or hemorrhages into the rear fluid
compartment of the eye, the vitreous). Hemolytic anemia other than sickle- cell
may result from transfusion of mismatched blood, which should be preventable
with today's knowledge and techniques for blood grouping.
It may also result
from Rh incompatibility (see page 562). In addition, this type of anemia may be
produced by some industrial poisons (such as benzol, aniline, TNT), and
sometimes by such substances as sulfonamide medications, quinine, lead, snakevenom, castor and fava beans. Outcome will depend on severity of the anemia and
on how quickly the cause can be deter- mined and eliminated, as well as on
prompt treatment with fluids, trans- fusions, and corticosteroid medications.
Another hereditary type of hemolytic anemia is thalassemia, which is subdivided
into major and minor categories.
