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Download B12 Deficiency
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Nikita Alicea DIAGNOSIS • Essential cofactor of methylation process of DNA & cell metabolism • Also referred to as cobalamin • Myelin synthesis & repair, RBCs formation • Deficiency causes megaloblastic anemia, damage to white matter of the spinal cord and brain, and peripheral neuropathy ICD-10 CODES D51.3 Other dietary vitamin B12 deficiency anemia D51.8 Other vitamin B12 deficiency anemias D51.9 Vitamin B12 deficiency anemia, unspecified PATHOGENESIS • Gradual onset usually after age of 60 • Higher rates among European & African descents (4% to 4.3%) • Causes: • Malabsorption of vitamin B12 • Pernicious anemia • Impaired ileal uptake • Dietary deficiency CLINICAL MANIFESTATIONS HISTORY Presentation: Ages any age group Sore tongue, numbness & tingling pf extremities Weakness, dizziness, diarrhea, constipation Dyspnea on exertion, palpitations Abdominal tenderness, dementia CLINICAL MANIFESTATIONS HISTORY • ROS & Health History: • Onset, duration and course of symptoms • Usual bowel habits, blood in stool • 24 hour recall of dietary intake • Pins & needles paresthesia • Weakness, fatigue & lethargy • Alcohol consumption • Medications; Rx. & OTC • Past medical history • Surgical history; Gastrectomy, resection of ileum • Autoimmune disorders CLINICAL MANIFESTATIONS PHYSICAL EXAM • • • • • • • • • Vital signs, weight & height – Weight loss Overall appearance- Premature aging Oral examination- Glossitis Eye and dermal examination- Icteric Heart, lungs & abdomen auscultation Abdominal palpation & percussion DTRs & mental status examination Finger nose coordination – Poor Romberg’s & Babinski’s sign - Positive CLINICAL MANIFESTATIONS DIAGNOSTIC TESTS • • • • • CBC with differential Peripheral smear Serum B12 level Serum methlymalonic acid Anti intrinsic factor antibodies • Anti parietal cell antibodies DIFFERENTIAL DIAGNOSES DIFFERENTIALS RED FLAGS • • • • Myelodysplasia Acute Hemolysis or Hemorrhage with brisk reticulocytosis Folic Acid Deficiency Aplastic Anemia Chronic liver disease Hypothyroidism TREATMENT • Vitamin B12 IM or Sub-q injections 100 mcg • Daily for a week, weekly for a month, then monthly for life • Oral methylcobalamin 1mg/day for life • Serum B12 monitoring • Patient Education-Life long therapy • Precautions • Follow up OUTCOMES • Patients are able to live normal healthy life and maintain daily activities • Symptoms are reversible with adherence to medication therapy • Regular follow up is important REFERENCES • Hunt A Harrington D Robinson S 2014 Clinical review; Vitamin B12 deficiency.Hunt, A., Harrington, D., & Robinson, S. (2014). Clinical review; Vitamin B12 deficiency. BMJ, 349, 1-10. • Cash J C Glass C A 2014 Family Practice GuidelinesCash, J. C., & Glass, C. A. (2014). Family Practice Guidelines (3 ed.). New York, NY: Springer Publishing Company. 20160427001408876202941 • Papadakis M A McPhee S J Rabow M W 2016 Current medical diagnosis & treatmentPapadakis, M. A., McPhee, S. J., & Rabow, M. W. (2016). Current medical diagnosis & treatment (55 ed.). New York, NY: McGraw-Hill Education. 2016042621264497191810 • Goroll A H Mulley A G 2014 Primary care medicineGoroll, A. H., & Mulley, A. G. (2014). Primary care medicine (7 ed.). Philadelphia, PA: Lippincott Williams & Wilkins. 201604262032451834736944 • Stabler S 2013 Clinical practice; Vitamin B12 deficiency.Stabler, S. (2013). Clinical practice; Vitamin B12 deficiency. The New England Journal of Medicine, 368, 149-160.
