The patient is an old alcoholic male, with low serum folic acid, high LDH, Smear show macroovalocytes what the TX
Give folic acid , for folic deficiency
A chronic alcoholic patient, AST>ALT, smear shows: Stomatocytes and Target cells, tx
Abstinence from alcohol and nutritional counseling. B12 or folic acid given if needed
Most B12 is stored in the liver, 1-10 mg,
which is a sufficient amount to support erythropoiesis for 2-5 years.*
patient has bilateral paresthesia of hands and feet. slowed reflexes.loss of memory/confusion.*Glossitis: beefy red tongue *
the most common cause of adult B12 deficiency. autoimmune where an anti-intrinsic factor antibody attacks the parietal cell which decreases transport of B12.
Schilling test < 7% excretion:,
, MCV > 100, macroovalocytes
megaloblastic anemia, depends on Shilling test but other causes respond to Intramuscular injection of 1000 micrograms of Cyanocobolamin weekly for 4-6 weeks, then monthly for life.
STAGE B12 ↓ excretion STAGE 2 B12/IF ↑ excretion STAGE 3 AFTER ABX N/A
Pernicious Anemia , Gastric Atrophy
Schilling Test,STAGE 1 B12↓ excretion, STAGE 2 B12/IF, STAGE 3 ABX ↓ excretion ↑
Bacterial Overgrowth excretion