-Serum Cbl <150 pmol/L on 2 separate occasions -Serum Cbl <150 pmol/L AND total serum homocysteine level >13 umol/L OR methylmalonic acid >0.4 umol/L
How is B12 deficiency compare to folate deficiency?
Folate deficiency mimicks the hematologic manifestations, but does not have the neurologic manifestations
Studies that confirm anatomic and physiologic consequences of B12 deficiency
Nerve conduction studies MRI
What does MRI of B12 deficiency show?
-Modest expansion of cervical and thoracic spinal cord -increased signal intensity of T2 weighted images, primarily in the dorsal columns and lateral pyramidal tracts
IM Vitamin B12 to build up stores and then on a monthly basis --> 1000 ug/d for 1 week THEN 1000ug/wk for 1 month THEN 1000 ug/month until cause of deficiency is corrected OR for life if cause is pernicious anemia -Treatment can reverse or stop most if not all sequelae of B12 deficiency
What is the difference between B12 deficiency and MS?
MS does not affect peripheral nerve conduction studies bc it is a disease of the Central Nervous system (not peripheral)