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Anemia perniciosa

 


Definizione

L’anemia perniciosa è dovuta alla carenza di vitamina B12. Le principali manifestazioni dell’anemia perniciosa sono dovute ad una carenza nutrizionale a causa di un’insufficienza da parte delle cellule parietali della mucosa gastrica a secernere il fattore intrinseco, ciò comporta un deficiente assorbimento della vitamina B12. L’ anemia perniciosa presenta un’incidenza maggiore nel nord Europa e, in generale è più comune nei bianchi. Gli orientali ne sono raramente affetti.

 

Fattori di rischio




Manifestazioni cliniche

L’anemia perniciosa è nella maggior parte dei casi una malattia dell’età media o avanzata. L’anemia cosiddetta giovanile si osserva raramente. Un tipo che si osserva nei bambini più grandi ha tutte le caratteristiche della malattia dell’adulto, compresa la formazione degli anticorpi contro le cellule parietali e contro il fattore intrinseco. L’inizio dei sintomi è insidioso e può trascorrere  qualche tempo prima che si giunga alla diagnosi. L’anemia perniciosa finché non è grave, è spesso ben tollerata; ma sintomi non specifici, come dispnea, anoressia, affaticabilità, irritabilità sono comuni. Alcuni pazienti si lamentano di dolore linguale che è legato ad una glossite cronica; questo sintomo può anche riscontrarsi nella carenza di folati, di ferro o di altre sostanze nutritive. A questo disturbo si associa di solito l’atrofia delle papille linguali. I pazienti spesso hanno precocemente capelli grigi e molti di essi presentano vitiligine. Talvolta si osserva una caratteristica tinta giallo limone della cute, forse attribuibile al pallone associato ad un lieve ittero. Comune un rialzo termico.

Alcuni sintomi neurologici quando si presentano in associazione con uno stato anemico, sono particolarmente suggestivi di una deficienza di vitamina B12:

  • Parestesie
  • Astenia
  • Coordinazione andatura incerta
  • Raramente incontinenza urinaria e fecale
  • Paralisi spastica
  • Modificazioni della personalità
  • Confusione
  • Psicosi

I sintomi suddetti possono essere erroneamente attribuite ad altre cause. Queste alterazioni neurologiche sono il risultato di una degenerazione zonale del sistema nervoso centrale e periferico; le cause precise di questo sono sconosciute.

 




Diagnosi

La diagnosi di anemia perniciosa viene fatta sulla base dell’ anamnesi e dei reperti fisici che suggeriscono una carenza di vit. B12. Una leucopenia e una piastrinopenia sono comuni quando l’anemia è grave. La diagnosi può essere confermata dalla dimostrazione che i livelli sierici di vitamina B12 sono bassi (inferiori a 100 μg per  100 ml) che essa è scarsamente assorbita dal tratto gastrointestinale, e che questo mal assorbimento è corretto dal fattore intrinseco​.

Analisi di laboratorio

 

  • Anemia macrocitica con riduzione dei reticolociti, 
    leuco-piastrinopenia.
  • Aspirato midollare: megaloblastosi dei precursori eritroidi. Modesta iperbilirubinemia libera con livello sierico della B12 ridotta.
  • Achilia gastrica istamino-resistente e anticorpi anti-fattore intrinseco nel siero e nel succo gastrico. 

 

Prognosi


La somministrazione parenterale di vitamina B12 provoca un incremento dei reticolociti entro una settimana e la correzione dell’anemia entro 1-2 mesi. 





Terapia


Esistono diversi schemi.

Uno dei più usati è il seguente:

  • 100 g µg di B12 /die per 7 gg per via parentale, poi mantenimento con 1000 µg ogni 30-90 giorni. In caso di lesioni neurologiche possono essere indicate dosi più elevate. I valori dell’ematocrito e dell’ emoglobina cominciano ad aumentare durante la prima settimana e  raggiungono livelli normali 1-2 mesi dopo l’inizio della terapia. Il quadro megaloblastico midollare si modifica rapidamente ed entro 24 ore il numero dei megaloblasti  può essere notevolmente ridotto. Il miglioramento clinico è evidente. La lieve ipertermia scompare rapidamente e il  dolore linguale si risolve 24-48 ore. L’aumento dell’appetito, ed un senso di benessere ricompaiono prima che si produca un considerevole miglioramento delle alterazioni ematologiche. I deficit neurologici sono meno responsivi alla terapia. le anomalie  comportamentali, la letargia e la confusione  scompaiono rapidamente.

 




Vitamina B12  

Gli alimenti ricchi di vitamina B12  sono soprattutto di origine animale. 

Di seguito indicate alcune fonti di vitamina B12.

    • Frutti di mare
    • Fegato e frattaglie 
    • Cereali fortificati con vitamina B12
    • Merluzzo
    • Tonno  
    • Sardine 
    • Sgombro 
    • Triglia 
    • Trota 
    • Maiale 
    • Coniglio 
    • Bovino 
    • Uova 
    • Formaggi stagionati come parmigiano, provolone. groviera 
    • Yogurt 
    • Latte 
    • Mozzarella

 

 




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