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(heartbeats that you’re aware of), particularly on exertion. In both disorders, a person’s mouth or tongue may be sore and his or her skin may appear pale yellow. If the spinal cord is affected by vitamin B12 deficiency anemia, a person may have difficulty walking and maintaining his or her balance. He or she may feel continuous tingling or coldness in the hands and feet, and may experience memory loss, confusion, or depression. See your doctor right away if you have any of these symptoms.

Diagnosis

If you have symptoms of vitamin deficiency anemia, your doctor will examine you and order blood tests to evaluate the level and appearance of your red blood cells. In vitamin deficiency anemia, the level of red blood cells is lower than normal and the red blood cells are larger than normal and underdeveloped. If you have anemia, your doctor will probably order additional tests to determine the underlying cause. Tell the doctor if you have a close relative who has pernicious anemia.

Treatment

Once lost, the digestive tract can never regain the ability to absorb vitamin B12. For this reason, treatment of pernicious anemia and most other types of vitamin B12 deficiency involves taking vitamin B12 injections (which you can administer yourself) for the rest of your life. Initially, you inject vitamin B12 once a day; eventually you inject the vitamin once a month. Problems with walking and balance may take months to improve and, if you had these problems for a long time before beginning treatment, they may not clear up completely. If you stop taking vitamin B12, your symptoms will gradually return.

To treat folic acid deficiency anemia caused by a poor diet, by an inability of the intestines to absorb adequate amounts of the vitamin, or by a greater-than-normal biological need for folic acid, a doctor usually prescribes folic acid supplements. He or she will also recommend changes in the person’s diet to take in adequate amounts of folic acid every day.

Preventing Vitamin Deficiency Anemia

The best way to prevent vitamin deficiency anemia is to eat a balanced diet that includes foods rich in vitamin B12 (such as lean red meat, low-fat or fat-free dairy products, and eggs) and folic acid (such as fresh fruits, orange juice, green leafy vegetables, and folic acid-fortified cereals and breads). Talk to your doctor about taking vitamin supplements.

Because smoking interferes with the body’s ability to absorb vitamins and increases the risk of vitamin deficiency anemia, quit smoking (see page 29) if you smoke. Cutting back on your intake of alcohol also may improve your body’s ability to absorb vital nutrients.

Sickle Cell Disease

Sickle cell disease is a life-threatening inherited form of hemolytic anemia (see page 616) in which hemoglobin (the oxygen-carrying protein in red blood cells) is abnormal. People who inherit a sickle cell gene from both parents develop sickle cell disease. Their red blood cells contain the defective hemoglobin that gives the cells their abnormal, sickle shape. People who inherit a sickle cell gene from only one parent have sickle cell trait. Their red blood cells contain half normal hemoglobin and half defective hemoglobin. Although they will not develop the disease, they can pass the sickle cell gene to their children.

In sickle cell disease, the abnormal, sickle-shaped red blood cells are fragile and have difficulty flowing through the capillaries, the smallest blood vessels in the body. The defective cells tend to clog the capillaries, preventing blood (and oxygen) from reaching tissues and organs, which can lead to severe tissue and organ damage. In addition, the abnormal red blood cells are destroyed faster than they can be replaced; this shortened life of red cells leads to iron deficiency anemia (see page 610).

Sickle-shaped red blood cells

In sickle cell disease, the body produces abnormal, sickle-shaped red blood cells (bottom). Normal red blood cells are doughnut-shaped (top). Healthy red blood cells flow easily through blood vessels, while sickle-shaped cells tend to block the