▲ Blood is taken for whole blood analysis to find out if there is ischemia such as vitamin B12, which leads to the onset of pernicious anemia; the picture shows the situation. (Photo credit: shutterstock)
Text / Jiang Junbin
▲ Figure 4: Atrophic glossitis improved after 2 weeks of treatment. (Photo provided by Jiang Junbin)
The tongue becomes red and smooth, the papillae disappears and the tongue is painful, even numb, and angular stomatitis occurs, the most common symptom of “pernicious anemia” in the mouth caused by vitamin B12 deficiency.
▲ Figure 3: An 80-year-old female patient with atrophic glossitis for approximately two months. (Photo provided by Jiang Junbin)
Before diagnosis, the patient must perform a whole blood test (CBC) to see if there is a deficiency of iron, ferritin, vitamin B12 and folic acid in the blood and if there are antibodies to the gastric parietal cells.
Please read on …
▲ Image 1: Nearly 60-year-old male, oral mucosa was burning, painful and tongue was numb for a year. White plaques were found on the back of the tongue two weeks ago. (Photo provided by Jiang Junbin)
Before diagnosis, blood must be drawn for a comprehensive blood test to confirm the condition
▲ Figure 2: Atrophic glossitis improved after two weeks of drug treatment. (Photo provided by Jiang Junbin)
According to the definition of the World Health Organization, female heme is less than 12 g / dl, male heme is less than 13 g / dl, iron is less than 60 μg / dl, vitamin B12 is less than 200 pg / mL and folic acid is less than 4 ng / mL Folic acid deficiency.
Pernicious anemia includes red blood cell counts less than 4 million / mm3, mean blood cell volume greater than 100 fL, vitamin B12 less than 200 pg / mL, homocysteine> 10 μM, and anti-parietal or anti-intrinsic antibody antibodies, thus affecting the absorption of vitamin B12.
Injectable therapeutic supplement B12 with folate, iron, protein
The method of treatment is not difficult, as long as the intramuscular injection of vitamin B12 and the supplementation of folic acid, iron and proteins can gradually return to normal. Vitamin B12 mainly maintains normal DNA synthesis and red blood cell proliferation, maintains the structure and function of nervous tissue, and also helps reduce the homocysteine concentration in the blood to keep it normal.
In two patients I recently met, one is a man in his 60s. Symptoms have been burning, pain and numbness of the oral mucosa for a year. Two weeks before seeing the doctor, white plaques were found on the back of the tongue (Figure 1). The cotton ball can be removed, so he went to the doctor. The test found that it was an oral Candida albicans infection. The blood test not only diagnosed pernicious anemia, but his pre-meal blood glucose was 150 mg / dl, and his glycosylated hemoglobin was greater than 7. He also had diabetes.
Therefore, the patient was injected with vitamin B12 once every two days and two folic acid tablets per day; oral candida infection was administered with the drug “Mycostatin”. After two weeks of treatment, the patient’s atrophic glossitis symptoms were significantly improved (Figure 2). He also consulted with an endocrinologist to treat his diabetes.
Another patient is an 80-year-old woman who has had symptoms of atrophic glossitis for about two months (Figure 3). Her tongue is red and smooth. She often feels burning, pain, numbness and other symptoms before seeking medical attention. The blood test showed that vitamin B12 is obviously deficient, the number of red blood cells and hemoglobin are severely insufficient, the blood cells are very large and there are anti-parietal cell antibodies, which is a typical pernicious anemia due to deficiency of blood. vitamin B12. After the intramuscular injection of vitamin B12 and the supplementation of folic acid, iron, protein, etc., the symptoms gradually disappeared.After two weeks, the tongue went from smooth to normal and the burning and pain of the tongue are disappeared (Figure 4).
(The author is the director and professor of the Oral Pathology Department of the Department of Dentistry at Hualien Tzu Chi Hospital)
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