▲ Blood is drawn for whole blood testing to know whether there is ischemia such as vitamin B12, which leads to the occurrence 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 papilla disappears, and the tongue is sore, even numb, and angular stomatitis occurs. This is the most common symptom of “pernicious anemia” in the oral cavity caused by lack of vitamin B12.
▲Figure 3: An 80-year-old female patient with atrophic glossitis for about two months. (Photo provided by Jiang Junbin)
Before diagnosis, the patient needs to do a whole blood (CBC) examination to see if there is iron, ferritin, vitamin B12 and folic acid deficiency in the blood, and whether there are antibodies against gastric parietal cells.
▲Picture 1: Nearly 60-year-old male, the oral mucosa was burning, painful, and the tongue was numb for one year. Two weeks ago, white plaques were found on the back of the tongue. (Photo provided by Jiang Junbin)
Before the diagnosis, blood should be drawn for a complete 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 World Health Organization definition, female heme is less than 12g/dL, male heme is less than 13g/dL, iron is less than 60μg/dL, vitamin B12 is less than 200pg/mL, and folic acid is less than 4ng/mL. Folic acid deficiency.
Pernicious anemia includes red blood cell count 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 cell antibodies, or anti-intrinsic factor antibodies, Thus affecting the absorption of vitamin B12.
Injectable B12 Therapeutic Supplementation with Folate, Iron, Protein
The treatment method is not difficult, as long as the intramuscular injection of vitamin B12, and supplementation of folic acid, iron, and protein, can gradually return to normal. Vitamin B12 mainly maintains normal DNA synthesis and red blood cell proliferation, maintains the structure and function of nerve tissue, and also helps to reduce the concentration of homocysteine in the blood to keep it normal.
In two patients I met recently, one is a man in his 60s. The symptoms are burning, pain and numbness of the oral mucosa for one year. Two weeks before seeing the doctor, white plaques were found on the back of the tongue (Figure 1). The cotton swab can be wiped off, so he came to the doctor. The test found that it was an oral Candida albicans infection. The blood test not only diagnosed pernicious anemia, but his blood sugar before meals was 150mg/dl, and his glycosylated hemoglobin was greater than 7%. He also suffered from diabetes.
Therefore, the patient was injected with vitamin B12 once every two days, and two folic acid tablets per day; the oral candida infection was administered with the drug “Mycostatin”. After two weeks of treatment, the patient’s symptoms of atrophic glossitis 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 on her tongue before seeking medical treatment. The blood test showed that vitamin B12 is obviously lacking, the number of red blood cells and hemoglobin are seriously insufficient, the blood cells are very large, and there are anti-parietal cell antibodies, which is a typical vitamin B12 deficiency pernicious anemia. After intramuscular injection of vitamin B12 and supplementation of folic acid, iron, protein, etc., the symptoms gradually disappeared. After two weeks, the tongue changed from smooth to normal, and the burning and pain of the tongue disappeared (Figure 4).
(The author is the director and professor of the Oral Pathology Department of the Dental Department of Hualien Tzu Chi Hospital)
☆Do not miss health news, follow by likefan page。
☆For more important medical news, please go toFree Health Network。
No need to draw, no need to grab, now use the APP to watch the news to ensure that you will win the lottery every dayClick me to download APP
Follow me to see how the event works