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Transcript
Internal Medicine
2)
Labeled cobalamine bound to IF is given orally
In pernicious anemia Vit B12 absorption is corrected i.e. the daily urinary excretion rate is
>8%
In patients with abnormal in terminal ileum or pancreatic insufficiency Vit B12 absorption will
not be corrected
3) Phase 2 repeated after 2 weeks of antibiotics
• Vit B12 absorption is corrected in patients with bacterial over growth such as (blind loop
syndrome)
• Administration of pancreatic extract corrects pancreatic insufficiency.
• Lack of/by pass of ileal intrinsic factor receptor (terminal ileal disease) or defective trans
enterocyt cobalamine transport can’t be corrected.
Treatment of megaloblastic anemia
1. Vit B12 Deficiency: is treated with Hydroxocobalamine which is given parentraly
•
Dose: Initial dose: 6 x 1000 µg over 2-3 weeks and Maintenance : 1000 µg every 3
months
•
Prophylactic therapy is indicated in patients with Total gastrectomy and Ileal resection
2. Folate deficiency: is treated with Folic acid preparation which is given orally
•
Dose: 5 mg Po daily
•
Prophylactic therapy is indicated in pregnancy, sever hemolytic anemia, in patients
with dialysis, and premature newborns
3. Additional measures:
•
Correct underlying cause
•
Antibiotics for bacterial over growth and treatment of fish tapeworm
Response to therapy
•
Feeling of general well being is restored in 48 hrs
•
Reticulocytosis begins in 3-4 days and peaks in 7-10 days.
•
If both folate and cobalamine deficiency present give cobalamine first
403