Pernicious Anemia and Other B Vitamin Deficiencies

Pernicious anemia is a type of anemia in which the intestines cannot effectively absorb vitamin B12, which results in a reduced count of red blood cells that are important for getting oxygen to the body's cells. 

You can get pernicious anemia when you don't get enough vitamin B12. People with a deficiency of vitamin B12 can't properly absorb this nutrient from their food. They can't make enough healthy red blood cells to meet their body's needs. 

Our red blood cells need vitamin B12 for normal cell growth. It makes red blood cells too big when there is not enough of a certain nutrient. Cells that are too big may not be able to leave the bone marrow where they were made. A low number of red blood cells means that there are fewer cells that can carry oxygen to the body's most important parts, like the brain and heart, as well as other parts and cells. 

People with pernicious anemia may be tired, have headaches and dizziness, chest pain, pale skin, cold hands, and cold feet. Additionally, vitamin B12 deficiency can also cause numbness in the hands and feet, muscle weakness, loss of reflexes, issues with balance, nausea, bloating, heartburn, and confusion.

Pernicious anemia blood tests can provide an accurate reading of your reticulocyte counts, serum folate, iron, and iron-binding. These tests can help show whether you have pernicious anemia or another type of anemia, with confidential results available in 1 to 2 days online when ordered from Ulta Lab Tests after specimen collection.

Listed below are lab tests to detect, diagnose and monitor pernicious anemia.

Find out what you should know about testing for pernicious anemia in the guide posted below is the list of anemia tests.

Name Matches

Pernicious Anemia Diagnostic Panel Includes

Intrinsic Factor Blocking Antibody, Methylmalonic Acid, Vitamin B12

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Folic acid deficiency is common in pregnant women, alcoholics, patients with diets that do not include raw fruits and vegetables, and people with structural damage to the small intestine. The most reliable and direct method of diagnosing folate deficiency is the determination of folate levels in both erythrocytes and serum. Low folic acid levels, however, can also be the result of a primary Vitamin B12 deficiency that decreases the ability of cells to take up folic acid. Vitamin B12 is decreased in pernicious anemia, total

Vitamin B12 is decreased in pernicious anemia, total or partial gastrectomy, malabsorption and certain congenital and biochemical disorders

Most Popular
Folic acid deficiency is common in pregnant women, alcoholics, in patients whose diets do not include raw fruits and vegetables, and in people with structural damage to the small intestine. The most reliable and direct method of diagnosing folate deficiency is the determination of folate levels in both erythrocytes and serum. Low folic acid levels, however, can also be the result of a primary vitamin B12 deficiency that decreases the ability of cells to take up folic acid

Folate levels have diagnostic significance in nutritional deficiencies, especially in cases of severe alcoholism, function damage to the upper third of small bowel, pregnancy and various forms of megoblastic anemia. Since serum folate levels are subject to rapid changes reflecting diet and absorption, RBC folate may be a better diagnostic tool since the levels remain fairly constant.

Before ordering this test consider The Complete Blood Count (CBC) with Differential and Platelets Blood Test (Test # 6399) which is a better value.

In Quest's internal studies of more than two thousand patient samples, no significant abnormalities were detected with manual differentials associated with test code 20253 that were not otherwise identified thru the test code 6399 CBC Reflex cascade.

This test is a CBC reflex test and it will include the components of the CBC (Includes Diff/PLT) with Smear Review based upon the test results of the following analytes if are above or below ranges as outlined in the test.

  • WBC 
  • Hemoglobin 
  • Hematocrit 
  • Platelet 
  • MCV 
  • MCH 
  • MCHC 
  • RBC 
  • RDW 
  • Relative Neutrophil % 
  • Relative Lymphocyte % 
  • Relative Monocyte % 
  • Eosinophil 
  • Basophil 
  • Platelet 

Most Popular

Useful in the diagnosis of hypochromic, microcytic anemias. Decreased in iron deficiency anemia and increased in iron overload.

Most Popular
For the diagnosis and monitoring of gastrin-secreting tumors, gastric ulcer, Zollinger-Ellison syndrome. Increased in pernicious anemia.

Most Popular
Elevated levels of homocysteine are observed in patients at risk for coronary heart disease and stroke.

Intrinsic Factor, produced by cells lining the stomach, binds vitamin B12 (cyanocobalamin) to facilitate absorption of the vitamin. Blocking antibody impedes the action of Intrinsic Factor as observed in approximately half of the patients who develop pernicious anemia.

Samples should not be collected from a patient who has received Vitamin B12 injection therapy within the last week.

Serum iron quantification is useful in confirming the diagnosis of iron-deficiency anemia or hemochromatosis. The measurement of total iron binding in the same specimen may facilitate the clinician''s ability to distinguish between low serum iron levels caused by iron deficiency from those related to inflammatory neoplastic disorders. The assay for iron measures the amount of iron which is bound to transferrin. The total iron binding capacity (TIBC) measures the amount of iron that would appear in blood if all the transferrin were saturated with iron. It is an indirect measurement of transferri

Most Popular

Lactate Dehydrogenase (LD) (LDH)

Elevations in serum lactate dehydrogenase occur from myocardial infarction, liver disease, pernicious and megaloblastic anemia, pulmonary emboli, malignancies, and muscular dystrophy

The methylmalonic acid (MMA) test may be used to help diagnose an early or mild vitamin B12 deficiency. It may be ordered by itself or along with a homocysteine test as a follow-up to a vitamin B12 test result that is in the lower end of the normal range.

Gastric Parietal Cell Antibodies (GPA) test results are used in the diagnosis of pernicious anemia.

Most Popular
Use in evaluating erythropoietic activity.

Pernicious Anemia is a type of anemia in which the intestines cannot effectively absorb vitamin B12, which results in a reduced count of red blood cells. In general, anemia is a condition that involves a lack of red blood cells, which are essential for transporting oxygen to the tissues of the body. There are various types of anemia, but pernicious anemia is a type of vitamin B12 anemia that is typically caused by an autoimmune problem. Here, we’ll discuss this rare condition, how it’s diagnosed, and how it can be treated. 

About Pernicious Anemia

When a person is diagnosed with pernicious anemia, their body cannot make enough red blood cells because it doesn’t have the necessary vitamin B12 to make them. Vitamin B12 is found in many foods, but people with this condition aren’t able to properly absorb this nutrient from food. The result is that they can’t make enough healthy red blood cells to serve their body’s needs. 

Our red blood cells require vitamin B12 for normal cell division. A lack of the nutrient causes red blood cells to be too large. Cells that are too large may fail to get out of the bone marrow where they’re produced. A reduced count of red blood cells means that there are fewer cells able to carry oxygen to the body’s essential organs like the brain and heart as well as other organs and tissues. 

What Causes Pernicious Anemia?

Pernicious anemia occurs because the body cannot absorb vitamin B12 from foods to adequately produce red blood cells. This is a rare problem, but an autoimmune response often causes it. Typically, pernicious anemia occurs because the protein in the stomach known as ‘intrinsic factor’ is diminished because the body’s own immune system mistakenly attacks it or the processes that produce it. Intrinsic factor is needed to help the body absorb vitamin B12. Without enough of this protein, the body, ultimately, can’t make an adequate supply of red blood cells.

Some cases of pernicious anemia involve an inherited disorder. Sometimes children are born with a disorder that prevents the body from making intrinsic factor. This condition is called congenital pernicious anemia. 

Other cases may relate to diet; for instance, a person can suffer from pernicious anemia if they don’t get enough vitamin B12 in their diet. A person’s ability to absorb vitamin B12 can also be compromised if another health condition is present such as celiac disease, Crohn’s disease, or HIV. Some medications can lead to vitamin B12 malabsorption in the small intestine. A tapeworm infection can also cause pernicious anemia. In some cases, gastric bypass procedures can also lead to this condition. 

Are There Risk Factors for Pernicious Anemia?

Medical researchers have found that there are certain risk factors that may make a person more susceptible to the development of this condition. These risk factors include: 

  • Northern European / Scandinavian descent
  • Family history of pernicious anemia
  • Having type 1 diabetes
  • Diagnosed with celiac disease or Crohn’s disease
  • Aged 60 or over

What Are the Signs and Symptoms of Pernicious Anemia?

Many of the signs and symptoms of pernicious anemia occur with all forms of anemia. Others are specifically related to the lack of vitamin B12 that occurs with this disorder. People who suffer from pernicious anemia may experience extreme fatigue, which is common to all forms of anemia. People feel tired because the body doesn’t have an adequate supply of red blood cells needed to carry oxygen to its organs and tissues. 

Other signs and symptoms of pernicious anemia include:

  • Headache
  • Dizziness
  • Chest pain
  • Pale skin
  • Cold hands and feet

While these symptoms can occur with any form of anemia, pernicious anemia also features symptoms that are particularly associated with a lack of vitamin B12. Symptoms of vitamin B12 deficiency include:

  • Hands and feet numbness
  • Muscle weakness
  • Loss of reflexes
  • Problems with balance
  • Confusion
  • Nausea
  • Bloating
  • Heartburn
  • Loss of appetite
  • Smooth and thick red tongue

Pernicious anemia can cause complications such as heart murmurs and even heart failure. Untreated pernicious anemia can be deadly. Fortunately, treatment can alleviate these symptoms, and people can usually recover to lead a normal life. 

How Is Pernicious Anemia Diagnosed?

Test results can support a diagnosis of pernicious anemia; however, many doctors may suspect the condition based on the symptoms present in the individual and a physical exam. Tests are necessary because the physician will need to know if the disorder is caused by a lack of intrinsic factor or something else. Doctors also need to learn how severe the condition is in order to provide the best possible treatment. Ulta Lab Tests can support a diagnosis of pernicious anemia. Its tests are reliable and easy to use.

What Are the Diagnostic Tests Available to Diagnose Pernicious Anemia?

Healthcare provides rely on blood tests to make a diagnosis of pernicious anemia as well as to understand what may be causing it. Each test can pinpoint some factor related to pernicious anemia, such as the presence of certain antibodies or abnormal blood cell counts. High levels of some elements like homocysteine can lead to a diagnosis of this condition. Some of the tests used most frequently to diagnose this disease are:

Complete Blood Count Panel

A complete blood count (CBC) tests various parts of the blood, such as hemoglobin and hematocrit. A low level of either of these elements may be indicative of anemia. Hemoglobin is a protein that’s rich in iron and helps the red blood cells deliver oxygen to parts all over the body. Hematocrit measures how much space in the blood is taken up by red blood cells. 

A CBC test provides a count of red blood cells, white blood cells, and platelets in the blood. If these counts are not in the normal range, a problem like pernicious anemia is likely present. Sometimes abnormal results can indicate a different problem, such as an infection. 

Finally, a CBC provides a measurement of red blood cell size. A telltale feature of pernicious anemia is red blood cells that are larger than normal. 

Other Tests to Diagnose Pernicious Anemia

If the CBC reveals the presence of pernicious anemia, more tests will be ordered to determine what is causing the disorder to occur. For instance, if a test uncovers intrinsic factor antibodies, the pernicious anemia is caused by an autoimmune response. Bone marrow tests may also be ordered to test the size of the marrow cells, which are typically larger in cases involving pernicious anemia.

Here is an overview of various tests used to diagnose pernicious anemia:

Note the following tests that rule out iron deficiency anemia:

  • Iron Total: iron and iron-binding capacity tests will indicate if pernicious anemia is present.
  • TIBC: this test measures iron binding capacity; a poor measure can indicate pernicious anemia. 
  • Ferritin: Pernicious anemia can cause low ferritin levels; if ferritin is tested low, the condition may be diagnosed.
  • Transferrin: this protein will be found in the blood if iron is low; low iron can indicate pernicious anemia.

How Is Pernicious Anemia Treated?

People who are diagnosed with pernicious anemia may require lifelong treatment that includes vitamin B12 injections. Treatment should prevent the anemia as well as its symptoms. If the cause of the pernicious anemia can be found, it may also be treated--if possible. Healthcare providers will also need to manage any complications that occur, such as heart or nerve damage. 

If you are diagnosed with pernicious anemia, your doctor may recommend either vitamin B12 pills or vitamin B12 injections. If your condition is severe, injections are usually prescribed first. Healthcare providers will inject vitamin B12 weekly or even daily in order to achieve the optimum amount of this vitamin in the bloodstream.

Once the vitamin B12 has reached a normal level, injections may only be required on a monthly basis. In cases that are less severe, patients may be prescribed pills or even a nose spray containing vitamin B12. Most people will experience symptom alleviation after a mere few days of treatment. Over the course of treatment, healthcare providers may adjust the dosing of vitamin B12 depending on the patient’s needs. 

Sometimes other treatments are needed to address other root causes of the pernicious anemia or to treat other conditions that the patient is experiencing, such as celiac disease. In many cases, patients may be able to administer their own injections of vitamin B12. Depending on the patient’s condition, they may receive these shots at home from a caregiver or may wish to travel to their health clinic to receive the injections. 

What about Pernicious Anemia Complications?

Health complications can occur as a result of untreated pernicious anemia. These might include heart irregularities or even heart failure. On the other hand, even with treatment, a person may experience health complications related to their anemia. For instance, gastric cancer is a dangerous complication that can occur with this condition. Doctors will monitor patients for signs of this condition. 

Other complications may include gastrointestinal problems, neurological problems (i.e. memory loss), and peripheral nerve damage. 

Living with Pernicious Anemia

People with pernicious anemia often live normal lives with treatment; however, they may require lifelong treatment and will need routine monitoring to ensure that no complications are arising and that the optimum dose of vitamin B12 is being provided. If you or a loved one is diagnosed with this condition, it’s important to meet with your physician on a regular basis to ensure that it’s managed effectively. 

Order Your Pernicious Anemia Tests with Ulta Lab Tests

Ulta Lab Tests offers tests that are highly accurate and reliable, so you can make informed decisions about your health.

  • Secure and confidential results
  • No insurance or doctor's referral is needed
  • Affordable pricing
  • 100% satisfaction guarantee

Order your pernicious anemia lab tests today, and your results will be provided to you securely and confidentially online in 24 to 48 hours for most tests.

Take control of your health today with Ulta Lab Tests.