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Vitamin B12 Deficiency Anemia


Presentation

  • Before surgery, two patients (6.6%) presented ferropenic anemia. Iron deficiency was seen in 40 and 54.5% 2 and 3 years after surgery, respectively. Cobalamin deficiency was observed in 33.3% at 2 years and in 27.2% at 3 years.[ncbi.nlm.nih.gov]
  • A 45–year–old black female presented with 2 weeks history of worsening fatigue, malaise, shortness of breath upon exertion and dizziness. She also reported irregular menstrual periods.[shmabstracts.com]
  • She is presently doing well without evidence of carcinoma relapse or metastasis.[ci.nii.ac.jp]
  • The following case has been diagnosed with both vitamin B12 deficiency and autoimmune hemolytic anemia that have been presented with seriously hemolysis and pancytopenia.[omicsonline.org]
  • Normal serum levels may be found in cases of deficiency where myeloproliferative disorders, liver disease, transcobalamin II deficiency, or intestinal bacterial overgrowth are present.[en.wikipedia.org]
Regurgitation
  • […] needed ] In 1907, Richard Clarke Cabot reported on a series of 1200 patients with PA; their average survival was between one and three years. [ citation needed ] William Bosworth Castle performed an experiment whereby he ingested raw hamburger meat and regurgitated[en.wikipedia.org]
Bleeding Gums
  • Symptoms can include: Diarrhea or constipation Fatigue, lack of energy, or lightheadedness when standing up or with exertion Loss of appetite Pale skin Feeling irritable Shortness of breath, mostly during exercise Swollen, red tongue or bleeding gums[medlineplus.gov]
  • Have a sore, red tongue or bleeding gums. Feel sick to your stomach and lose weight. Have diarrhea or constipation. If the level of vitamin B12 stays low for a long time, it can damage your nerve cells.[medicalrecords.com]
Long Tract Signs
  • Symptoms of B12 deficiency include those caused by the anemia (shortness of breath, fatigue, and weakness) plus paresthesias, loss of deep tendon reflexes, long tract signs, impaired proprioception and vibratory senses, unsteady gait, spastic paraplegia[thebigl.co]
Absent Ankle Reflex
  • ankle reflex, increased knee reflex response, and extensor plantar response. [22] Other than anemia, hematological symptoms may include cytopenias, intramedullary hemolysis, and pseudothrombotic microangiopathy. [1] Pernicious anemia can contribute to[en.wikipedia.org]
Mild Cognitive Impairment
  • cognitive impairment (including difficulty concentrating and sluggish responses, colloquially referred to as brain fog ), and even psychoses, impaired urination, [17] loss of sensation in the feet, unsteady gait, [21] difficulty in walking, [18] muscle[en.wikipedia.org]

Workup

  • Thus, pernicious anemia must be differentiated from other disorders that interfere with the absorption and metabolism of vitamin B-12 (see DDx and Workup ).[emedicine.medscape.com]
Schistocytosis
  • Peripheral blood smear showed schistocytosis, anisocytosis, and poikilocytosis with hypersegmented neutrophils.[shmabstracts.com]
Anisocytosis
  • Peripheral blood smear showed schistocytosis, anisocytosis, and poikilocytosis with hypersegmented neutrophils.[shmabstracts.com]
  • […] volume (MCV 100 fL) and mean corpuscular hemoglobin (MCH) Reticulocyte count is decreased due to destruction of fragile and abnormal megaloblastic erythroid precursor Platelet count may be reduced Neutrophil granulocytes may have hypersegmented nuclei Anisocytosis[pathologyoutlines.com]
Homocysteine Increased
  • An increase in both MMA and homocysteine can distinguish between B 12 deficiency and folate deficiency because only homocysteine increases in the latter. [40] [42] Elevated gastrin levels can be found in around 80-90% of PA cases, but they may also be[en.wikipedia.org]
Hypercellular Bone Marrow
  • The hypercellular bone marrow with megaloblastic changes and the peripheral smear with hypersegmented neutrophils indicated Folic Acid or Vitamin B12 Deficiency.[shmabstracts.com]

Treatment

  • Paraoxonase and arylesterase activities significantly increased after treatment with vitamin B(12) in vitamin B(12) deficiency anemia; however, there were no significant changes in the activities of these enzymes after iron treatment in iron deficiency[ncbi.nlm.nih.gov]
  • The goal of treatment is to increase your vitamin B12 level. Treatment may include a shot of vitamin B12 once a month. If you have a very low level of B12, you may need more shots in the beginning.[medlineplus.gov]
  • Treatment may include vitamin B 12 shots (injections) and folic acid pills.[hopkinsmedicine.org]
  • Treatment is corticosteroid therapy, therapeutic splenectomy in case who failed to respond to treatment. It has been often noted that most of cases are female [ 6 ].[omicsonline.org]
  • Sublingual/intranasal delivery [ edit ] Sublingual treatments have also been postulated to be more effective than oral treatments alone.[en.wikipedia.org]

Prognosis

  • Prognosis The outlook is excellent because this form of anemia responds well to treatment. However, it is possible that nerve cell damage will be permanent.[drugs.com]
  • What Is the Prognosis for Pernicious Anemia (Vitamin B-12 Deficiency)? Pernicious anemia is easily and effectively treated by the administration of vitamin B-12. Lifelong treatment is required.[emedicinehealth.com]
  • […] for PA has been intramuscular injections of cobalamin in the form of cyanocobalamin (CN-Cbl), hydroxocobalamin (OH-Cbl) or methylcobalamin. [47] Oral doses [ edit ] Treatment with high-dose vitamin B 12 orally also appears effective. [47] [48] [49] Prognosis[en.wikipedia.org]
  • In general, the prevalence of pernicious anemia is probably underestimated, due to the complexity of the diagnosis. [6] Prognosis The disease is called pernicious anemia because it was fatal prior to the discovery that it was a nutritional disorder.[emedicine.medscape.com]

Etiology

  • If the urine level rises greater than 8% in the second phase, pernicious anemia is the underlying etiology.[thebigl.co]
  • The eradication of H pylori was associated with recovery from anemia and increased serum vitamin B12 level (P CONCLUSIONS: H pylori seems to be an etiologic factor in vitamin B12 deficiency, since anemia was cured and the level of vitamin B12 in the serum[ncbi.nlm.nih.gov]
  • Case 35-year-old male patient who was Syria refugees and consulted with us due anemia and etiology of pancytopenia by internal medicine service has been admitted and examined by hematology ward.[omicsonline.org]
  • Children who develop cobalamin deficiency usually have a hereditary disorder, and the etiology of their cobalamin deficiency is different from the etiology observed in classic pernicious anemia.[emedicine.medscape.com]
  • […] and thymidine synthesis, myelin production, protein / neurotransmitters / fatty acid / phospholipid production and DNA methylation, which becomes deficient in these individuals Methylmalonyl-CoA to succinyl-CoA also requires Vitamin B12 as a cofactor Etiology[pathologyoutlines.com]

Epidemiology

  • Section, Division of Epidemiology, Statistics, and Prevention Research, 6100 Building, Room 7B03, NICHD, NIH, DHHS, Bethesda, MD 20892.[ajcn.nutrition.org]
  • Definition / general Vitamin B12 deficiency, also known as hypocobalaminemia, refers to low blood levels of vitamin B12 Epidemiology 6% of those under age 60 and 20% over age 60 Rates may be as high as 80% in parts of Africa and Asia Pathophysiology Total[pathologyoutlines.com]
  • Epidemiology: - Individuals older than 30 - Northern European descent (primarily Scandinavian, English and Irish) - More likely in females (black females having earlier onset) (McCance, Heuther, Brashers & Rote, 2014) Disease described: Vitamin B12 deficiency[wikilectures.eu]
  • Epidemiology The adult form of pernicious anemia is most prevalent among individuals of either Celtic (ie, English, Irish, Scottish) or Scandinavian origin. In these groups, 10-20 cases per 100,000 people occur per year.[emedicine.medscape.com]
  • An association has been observed between pernicious anemia and certain types of gastric cancer, but a causal link has not been established. [27] Epidemiology [ edit ] PA is estimated to affect 0.1% of the general population and 1.9% of those over 60,[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Detailed pathophysiology at cellular, tissue, organ and systems levels: Cobalamines come from the family of Vitamin B12 and is a cofactor for intra-cellular biochemical reactions.[wikilectures.eu]
  • Definition / general Vitamin B12 deficiency, also known as hypocobalaminemia, refers to low blood levels of vitamin B12 Epidemiology 6% of those under age 60 and 20% over age 60 Rates may be as high as 80% in parts of Africa and Asia Pathophysiology Total[pathologyoutlines.com]
  • […] indicated that the formation of antibodies to gastric cells was autosomal dominant gene determined, and the presence of antibodies to the gastric cells might not be necessarily related to the occurrence of atrophic gastritis related to PA. [32] [34] Pathophysiology[en.wikipedia.org]
  • Pathophysiology Classic pernicious anemia is caused by the failure of gastric parietal cells to produce sufficient IF (a gastric protein secreted by parietal cells) to permit the absorption of adequate quantities of dietary vitamin B-12.[emedicine.medscape.com]

Prevention

  • CONCLUSION: Our routine scheme of vitamin supplementation is not sufficient to prevent iron and vitamin B12 deficiencies in most patients.[ncbi.nlm.nih.gov]
  • However, eradication of H pylori from gastric mucosa alone is not enough to prevent gastric recurrence of the bacteria. Proper oral hygiene must be established to eliminate H pylori in dental plaque.[ncbi.nlm.nih.gov]
  • You can prevent anemia caused by a lack of vitamin B12 by eating a well-balanced diet. Shots of vitamin B12 can prevent anemia after surgeries known to cause vitamin B12 deficiency.[medlineplus.gov]
  • Can vitamin B12 deficiency anemia be prevented? Most people who eat animal products like milk, cheese, and eggs will not get this B12 deficiency anemia.[medicalrecords.com]

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