Vitamin B 12 Deficiency

Dear Lisa,

My husband is 47 years old and has just been diagnosed with long term B12 deficiency. He has severe symptoms including dementia. He was also just diagnosed with diabetes about 2 months later. He also has spinal cord compression in several areas of his neck and back.

My question is this. My husband was an Rh factor baby born in 1959. The doctor thought transfusion was too dangerous and thought to put him on B-12 shots until he was about 6 years old. He ate lamb chops for breakfast for that time too.

Would his Rh problem affect him today? We just found out about this problem and we’ll tell his neurologist and internal med doctor this as soon as we see them again. I am just interested to know if there is a connection here or not.

Thank you in advance for any opinion you may have.

“B 12 Deficiency in Oklahoma”

Dear “B 12 deficiency in Oklahoma”,

I am sorry to hear about your husband’s B12 deficiency, Diabetes, Dementia and spinal cord compression. As you may already know, the Vitamin B 12 is essential for normal bone marrow function and has an indirect effect on the formation of Red Blood Cells. (1,2) The Vitamin B 12 also is necessary for the formation of the amino acid methionine, the formation of folacin and for the manufacture of choline.(1,3) Deficiency in Vitamin B 12 can lead to Pernicious anemia, malfunction of the nervous system due to degeneration of axons of the spinal cord, Gastrointestinal problems and neurologic deterioration.(1,3)

Pernicious Anemia develops when the lining of the stomach fails to secrete sufficient amounts of intrinsic factor which is needed for the absorption of Vitamin B 12. This type of anemia is more common in the elderly because of their decreased amount of gastric secretion. When the body is deprived of Vitamin B 12 the bone marrow produces less Red blood cells, but the Red blood cells that are produced are larger in size. The red cells that are produced are usually immature and fragile which makes them more susceptible to being destroyed during circulation.(2) This is the process that leads to anemia.

The Vitamin B 12 can be found in liver, organ meats, milk, eggs, cheese meat, fish and soybeans(1) Vitamin B 12 is not found in vegetables and this is why Vitamin B 12 deficiency is a risk for people who follow a strict vegetarian diet. (4) In order to prevent B 12 deficiency, you should eat foods that contain Vitamin B 12. Even if an adequate amount of Vitamin B 12 is ingested from the diet, B 12 deficiency can still occur. The absorption of Vitamin B 12 is dependent upon the secretion of Hydrochloric Acid and intrinsic factor by gastric mucosa. (3) If a person has a deficit in his gastrointestinal mucosa he can develop Vitamin B 12 deficiency regardless of the type of diet that he is on.

On the other hand, the anemia that results from Rh factor has a different cause. The Rh factor occurs when a pregnant mother’s blood is Rh negative and the baby’s blood is Rh positive. If some of the fetus’s blood leaks into the mother’s blood stream, such as during an amniocentesis, an abortion or during birth, the mother’s body makes cells that attack the baby’s blood. This occurs because the mother's body identifies the baby's Red Blood cells as foreign. As a result the Rh positive baby or subsequent babies suffer due to blood hemolysis. Hemolysis is the swelling and rupture of the Red blood cells. If this occurs the baby can develop Erythroblastosis fetalis or Hemolytic Disease of the newborn.(3)

Before the vaccine RhoGAM became available in the late 1960’s Hemolytic Disease of the newborn due to Rh incompatibility occurred in 0.5% to 1% of all mature pregnancies in North America.(5) Many babies died or became seriously ill from this disease. Exchange transfusions as well as replacement transfusions saved many lives.(5) If severe Hemolytic Disease of the newborn is left untreated about 10% are expected to develop kernicterus. (5) Kernicterus is a type of encephalopathy caused by increasing bilirubin(a product of broken Red Blood cells) levels. Complete recovery is expected in most infants who do not develop kernicterus.(5)

It is very fortunate that your husband survived his Rh factor incompatibility at birth, since many babies from that era did die. In regards to your question about your husband's new diagnosis of B 12 deficiency and Rh factor at birth, it is not likely that they are related. Pernicious anemia and hemolytic Disease of the newborn fall into two separate categories of anemia. Each type of anemia has a different cause.

Your husband's Internist would be the best person to ask about the cause of his B 12 deficiency. It would also be a good idea to inquire about Pernicious Anemia and any treatments that may be needed to help his condition. Unfortunately my area of practice is limited to the pediatric population and I do not have enough experience regarding alterations in the health conditions of adults. My experience with Vitamin B12 deficiency is limited to breastfeeding infants whose mothers are on a strict vegetarian diet, or in teenagers who have insufficient Vitamin B12 intake due to their diet.(4)

The good thing is, now that B 12 deficiency has been identified, you can better understand your husband’s health problems and he can receive the treatment that he needs. I hope this information helped and I wish you and your husband well.

References:
(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 100.
(2)Waley L, Wong D. Nursing Care of Infants and Children. 2nd ed. St. Louis Missouri:The C.V. Mosby Company.1983:468,1342.
(3)Tortora G, Anagnostakos N. Principles of Anatomy and Physiology. 4th ed. Sao Paulo, Sidney:Biological Sciences Textbooks, Inc. 1984:649, 449-450.
(4)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:574.
(5)Jensen M, Bobak I. Maternity and Gynecologic Care. 3rd ed. St. Louis Missouri: The C.V. Mosby Co. 1985:1125-1128.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Advice About Pediatric Health Conditions