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D51.0 – Pernicious Anaemia (ICD-10)
D51.0 is the ICD-10 code for vitamin B12 deficiency anaemia due to intrinsic factor deficiency, also known as pernicious anaemia. It results from impaired absorption of vitamin B12 in the gut.
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D51.0 is the ICD-10 code for vitamin B12 deficiency anaemia due to intrinsic factor deficiency, also known as pernicious anaemia. It results from impaired absorption of vitamin B12 in the gut.
Definition
D51.0 is the ICD-10 code for vitamin B12 deficiency anaemia due to intrinsic factor deficiency, commonly referred to as pernicious anaemia (Biermer's disease). In this condition, the body is unable to absorb sufficient vitamin B12 from food because a critical transport protein called intrinsic factor is absent or inadequately produced.
Causes
Intrinsic factor is produced by specialised cells in the gastric mucosa known as parietal cells. It is essential for the absorption of vitamin B12 in the small intestine (ileum). In D51.0, the underlying cause is most often an autoimmune condition:
- Autoimmune gastritis type A: The immune system attacks and destroys the parietal cells of the stomach.
- Formation of antibodies directed against intrinsic factor itself, rendering it non-functional.
- Rarely: congenital absence of intrinsic factor (congenital pernicious anaemia).
Symptoms
Because vitamin B12 is essential for red blood cell production and nerve function, its deficiency can cause a wide range of symptoms:
- Anaemia: Pallor, fatigue, weakness, shortness of breath
- Neurological symptoms: Tingling or numbness in the hands and feet, difficulty walking, cognitive impairment (subacute combined degeneration of the spinal cord)
- Gastrointestinal complaints: Burning tongue, smooth red tongue (Hunter's glossitis), loss of appetite
- Psychological changes such as memory loss or depressive mood
Diagnosis
Diagnosis is based on a combination of clinical findings and laboratory investigations:
- Full blood count: Macrocytic, hyperchromic anaemia (enlarged red blood cells)
- Measurement of serum vitamin B12 levels (reduced)
- Detection of antibodies against intrinsic factor and against parietal cells
- Elevated homocysteine and methylmalonic acid levels in the blood
- Gastroscopy with biopsy if autoimmune gastritis is suspected
Treatment
Since oral absorption of vitamin B12 is not possible in the absence of intrinsic factor, treatment typically involves:
- Intramuscular vitamin B12 injections (cyanocobalamin or hydroxocobalamin), given frequently at first (daily or weekly), then monthly as long-term maintenance therapy
- In some cases, high-dose oral vitamin B12 (1000 µg/day) may be effective, as a small fraction can be absorbed passively without intrinsic factor
- Treatment must generally be continued for life
- Regular monitoring of blood counts and vitamin B12 levels is recommended
References
- Stabler SP. Vitamin B12 Deficiency. New England Journal of Medicine. 2013;368(2):149-160.
- Langan RC, Goodbred AJ. Vitamin B12 Deficiency: Recognition and Management. American Family Physician. 2017;96(6):384-389.
- World Health Organization (WHO): Nutritional Anaemias: Tools for Effective Prevention and Control. Geneva, 2017.
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