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Internal Medicine
Labeled cobalamine bound to IF is given orally
In pernicious anemia Vit B12 absorption is corrected i.e. the daily urinary excretion rate is
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
• 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
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