Vitamin B12 Deficency Flashcards
What are the causes of B12 deficiency?
pernicious anaemia (commonly)
post gastrectomy
vegan diet or a poor diet
disorders/surgery of terminal ileum (site of absorption)
Crohn’s: either diease activity or following ileocaecal resection
metformin (rare)
What are the features of B12 deficiency?
macrocytic anaemia
sore tongue and mouth
neurological symptoms
neuropsychiatric symptoms: e.g. mood disturbances
What neurological symptoms can arise due to B12 deficiency?
dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
What is the management for B12 deficiency with no neurological involvement?
1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
+/-
Oral folic acid
Referral to neurologist and/or haematologist
How does folate deficiency present?
Megaloblastic anaemia
Absence of neurological signs
What are some causes of folate deficiency?
Malabsorption Drugs and toxins States of increased demands Dietary deficiency Hereditary (rare)
What is maternal folate deficiency associated with?
Neural tube defects
Why must B12 deficiency be ruled out before initiating treatment folic acid therapy?
therapy may mask neurological manifestations of underlying vitamin B12 deficiency
What foods are rich in folate?
green vegetables, legumes, and some fruits
What are RFs for folate deficency?
Low dietary folate intake >65 years Alcohol-use disorder Pregnant or lactating Prematurity Intestinal malabsorptive disorders Drugs e.g. methotrexate Congenital defects Exclusive goats milk consumption in infancy
