Vitiligo and pernicious anaemia

Last Updated on 29th May 2021 by Caroline Haye

I have been aware for a long time that vitiligo is sometimes associated with pernicious anaemia. (Please excuse the British spelling if you are not from the UK). So I finally decided to look at this subject in more detail and pass the information on.  I hope you find it useful.

Firstly, what is anaemia?  Well, the word “anaemia” literally means “no blood”.  It is a condition in which there is a deficiency of red cells or of haemoglobin in the blood, usually resulting in pallor and fatigue.  Pernicious anaemia is just one of a number of different types or anaemia.

Types of anaemia

These, in brief, are some of the others:

• Iron deficiency anaemia – this is the most common type, the one that most people tend to think of first, and the simplest to treat.
• Thalassaemia – an inherited blood disorder in which the body makes fewer healthy red blood cells and less haemoglobin (an iron-rich protein in red blood cells).
• Aplastic anaemia – a rare and serious blood disorder in which the body’s bone marrow doesn’t make enough new blood cells.
• Haemolytic anaemia – a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is up.
• Sickle cell anaemia – a serious, inherited disease in which the body makes sickle-shaped (“C”-shaped) red blood cells that usually die after about 10 to 20 days so the body can’t reproduce red blood cells fast enough to replace the dying ones.
• Fanconi anaemia, or FA – a rare, inherited blood disorder that leads to bone marrow failure.

As far as I am aware there is no connection between vitiligo and any of the above.  The only link is with pernicious anaemia. 

So what exactly is pernicious anaemia?

Pernicious anaemia, as distinct from the other types, is a condition in which the body can’t make enough healthy red blood cells because it doesn’t have enough vitamin B12.  It is classified as an autoimmune disease and is the most common cause of vitamin B12 deficiency.   Sometimes people develop pernicious anaemia because they don’t get enough vitamin B12 in their diets or through poor absorption due to a variety of factors like: the wrong bacteria in the small intestines; certain medicines; surgical removal of part of the small intestine; or even tapeworm infection.  But in most cases it is the body’s own immune system that attacks the stomach cells that produce “intrinsic factor”, a protein which is vital for the absorption of vitamin B12.

Whatever the reason for this malabsorption problem, I find it all the more interesting given that so many vitiligo sufferers, in my experience, report having digestive problems.  (I came to the conclusion several years ago that my own vitiligo was due to nutritional deficiencies caused by malabsorption.)   Interestingly too, vitamin B12 deficiency is often accompanied by low stomach acid (hypochlorhydria) which is another common condition among those with vitiligo.

Happily, vitamin B12 deficiency can be treated relatively easily – albeit for life – by regular supplements or injections of vitamin B12.  But first, of course, you have to know for sure that you have it, so it has to be diagnosed.  Having vitiligo is one very good reason to ask your doctor to check for vitamin B12 deficiency.   If, in addition to vitiligo, you also have any of the vitamin B12 signs and symptoms listed below, you would definitely be wise to get yourself checked out.

Symptoms of pernicious anaemia

• Fatigue and lethargy
• Faintness or dizziness
• Palpitations
• Headache
• Nerve damage
• Shortness of breath
• Tinnitus
• Mouth ulcers
• Neurological problems, e.g. confusion, dementia, depression, and memory loss.
• Digestive problems, e.g. nausea, vomiting, heartburn, bloating, gas, constipation or diarrhoea, loss of appetite, and weight loss.
• An enlarged liver
• A smooth, “beefy red” tongue
• Infants who have vitamin B12 deficiency may have poor reflexes or unusual movements, such as face tremors.

Risk factors for pernicious anaemia

It is also worth considering the risk factors below, especially since having vitiligo is one of them:

You are at higher risk for pernicious anaemia if you have…

• A family history of the condition.
• Had part or all of your stomach removed.
• Certain autoimmune disorders that involve the endocrine glands, such as Addison’s disease, type 1 diabetes, Graves’ disease, and vitiligo.
• Had part or all of your small intestine removed.
• Certain intestinal diseases or disorders that prevent your body from properly absorbing vitamin B12.
• Taken medicines that prevent your body from properly absorbing vitamin B12.
• A strict vegetarian diet and don’t take a vitamin B12 supplement, or if you eat poorly overall.

If you do get tested for vitamin B12 deficiency (or if, like me, you have tested negative in the past) it is worth bearing in mind that false negative results with this test are quite common, as this website points out:

“False negatives (normal levels in the presence of deficiency) may occur in true deficiency, liver disease, lymphoma, autoimmune disease and myeloproliferative disorders. In borderline cases or where B12 deficiency is clinically suspected, other tests must be carried out [..…] Folic acid levels should be measured to exclude deficiency, which may co-exist with B12 deficiency…”

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