Condition- B12 and Folate deficiency Flashcards
1
Q
List some causes of B12 deficiency
A
- Inadequate intake: Vegan Diet, B12 is found in meat and animal products
- Gastric- parietal cells
- Pernicious anaemia- autoantibodies against gastric parietal cells which produce intrinsic factor- needed for B12 absorption
- Gastrectomy
- Intestinal- ileum
- Malabsorption- crohns
- ileal resection
- Drugs
2
Q
State two drugs which reduce the absorption of B12
A
Colchicine
Metformin
3
Q
List some of the symptoms of B12 deficiency
A
Typical anaemia symptoms:
- Fatigue
- lethargy
- SOB
- Faintness
- palpitations
Neurological symptoms:
- paraesthesias
- numbness
- cognitive change
- visual disturbance
4
Q
List some of the signs of B12 deficiency on physical examination
A
- Pallor
- Heart failure- anaemia
- Glossitis
- Angular stomatitis
- Neuropsychiatirc: irritability, dementia, depression
- Neurological:
- dorsal columns affected first
- joint position
- vibrational
- Ataxia + +ve rombergs
- peripheral neuropathy
- dorsal columns affected first
5
Q
Which part of the spinal tract is affected first in B12 deficiency and how does this manifest?
A
- Dorsal columns
- Decreased vibrational sense
- loss of joint positional sense
- +ve Rombergs
6
Q
What might you see on a blood film of someone withhhhh B12 deficiency?
A
- Hypersegmental neutrophils
- Oval macrocytes
- Circulating megaloblasts
- nuclear cytoplasmic dissociation
7
Q
What are the first line investigations to order for someone with B12 deficiency? What would you see?
A
- FBC: High MCV, low Hb/Hct
- Blood smear: megaloblasts, hypersegmented neutrophils
- Serum B12- not reliable
- Other tests: plasma homocysteine, plasma methylmalonic acid, holotranscobalamin
8
Q
How could you diagnose Pernicious anaemia as the cause of B12 deficiency?
A
- Anti-intrinsic factor antibodies
- Anti-parietal antibodies
- Schilling test
