يعد نقص فيتامين بي 12 أحد المشاكل الشائعة التي يعاني منها العديد من الأشخاص ويعود ذلك لأسباب عدة.
يوجد العديد من الأطعمة الغنية بفيتامين B12، مثل: اللحم والبيض ومنتجات الحليب، ويرتبط الفيتامين في المعدة بالعامل المعدي الداخلي (Gastric intrinsic factor) ليتم بعد ذلك امتصاصهما معًا كمركب واحد إلى داخل الجسم.
مراحل نقص فيتامين B12
تتطور مراحل نقص فيتامين B12 إلى عدة مراحل كما يأتي:
- المرحلة الأولى
في هذه المرحلة يحدث انخفاض في مخزون فيتامين B12 في الجسم، ما يسبب انخفاض في مستوياته في مصل الدم بشكل قليل.
- المرحلة الثانية
عدم فاعلية الفيتامين إذ يكون ارتفاع في مستويات عدة أنواع من الفضلات في المصل (Metabolites)، مثل: هوموسيستاين، وحمض الميثيل ملونيك (Methyl malonic acid)، وفي هذه المرحلة تقل مستويات الفيتامين عن الحد الطبيعي.
- المرحلة الثالثة
في هذه المرحلة يحدث فقر الدم إضافة إلى الاعتلال العصبي (Demyelination)، الأمر الذي يؤدي إلى ظهور الأعراض النموذجية لنقص فيتامين B12.
أعراض نقص فيتامين B12
يمكن تقسيم أعراض نقص فيتامين B12 كما يأتي:
- أعراض أكثر شيوعًا
تشمل أعراض نقص فيتامين B12 السريرية التقليدية لفقر الدم فيما يأتي:
- التعب.
- انخفاض الوزن.
- خدر في كفوف الأقدام.
- فقدان الإحساس.
- الاهتزاز (Vibration)
- أعراض أقل شيوعًا
وتشمل ما يأتي:
- اضطرابات في الذاكرة والتركيز.
- تغييرات في المزاج.
- الإكتئاب
- اضطرابات في النوم.
- ضعف في الرؤية.
- اضطرابات مناعية (Autoimmune).
- اضطرابات مختلفة في الجهاز الهضمي.
- مشاكل في الخصوبة.
أسباب وعوامل خطر نقص فيتامين B12
يمكن أن ينتج نقص فيتامين B12 لعدة أسباب، وتشمل ما يأتي:
- نقص في التغذية.
- اضطرابات في امتصاص الطعام سواء كان في المعدة أو الأمعاء الدقيقة.
- اضطراب الامتصاص ناتج عن نقص العامل المعدي الداخلي (Gastric intrinsic factor).
- ضمور الغشاء المخاطي للمعدة.
- مرض فقر الدم الوبيل (Pernicious anemia).
- استئصال كامل أو جزئي للمعدة.
- متلازمة زولينجر- إيليسون (Zollinger – ellison syndrome).
- التهابات في الأمعاء.
- ضرر في أقصى الأمعاء الدقيقة اللفائفية (Lymphoma).
- استئصال الأمعاء الدقيقة.
- أمراض البنكرياس.
- نقص الامتصاص الخاص الكوبالامين والبيلَّة البروتينية (Protinuria).
مضاعفات نقص فيتامين B12
يزيد نقص فيتامين B12 من احتمالية الإصابة بتصلب الشرايين، لذلك ستصبح فحوصات قياس مستويات فيتامين B12 في المستقبل جزءًا من الفحوصات الروتينية في المجتمع، كما هو حال فحوصات الدهنيات أو مستويات السكر في الدم
تشخيص نقص فيتامين B12
يعتمد التشخيص على فحص العديد من المواد في الجسم تدل على المشكلة كما يأتي:
- إيجاد أجسام مضادة ضد الخلايا الجدارية (Parietal cell).
- مستويات غاسترين (Gastrin) مرتفعة في الدم.
- اختبار شيلينغ المعدّل (Shilling test) بواسطة إضافة العامل الداخلي.
- فحص مستويات بعض المواد، مثل: هوموسيستاين، وحمض الميثيل ملونيك (Methylmalonic acid).
علاج نقص فيتامين B12
يتم علاج نقص فيتامين B12 من خلال ما يأتي:
- الحقن
يساعد إعطاء حقن فيتامين B12 داخل العضلة على تصحيح النقص وتعبئة المخزون، ويتم أخذ الحقن عادةً على شكل حقنة يومية لمدة أسبوعين، أو حقنة في الأسبوع لـمدة 4 – 6 مرات، ثم حقنة واحدة كل شهر.
- الأدوية
يوجد هناك أيضًا أدوية تعطى عن طريق الفم، أو المص، أو تحت اللسان، أو مرهم للدهن على الغشاء المُخاطي في الأنف.
لا تكون الأدوية كافية لتصحيح النقص الشديد في فيتامين B12، إلا أنها قادرة على منع تقدم المرض لدى الأشخاص الموجودين في حالة خطر مرتفع.
الوقاية من نقص فيتامين B12
يمكن الوقاية من الإصابة بنقص فيتامين B12 من خلال تجنب عوامل الخطر التي تسبب الإصابة بهذه الحالة قدر الإمكان.
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