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FAB, folate deficeincy, alcoholism, b12-deficeincy
folate deficiency cause
inadequate intake, alcoholics, elderly, intestine ds, meds like methroxate
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
*For folic deficiency TX, large doses of pheytoin may cause
increase frequency of seizures
A chronic alcoholic patient, AST>ALT, smear shows:
Stomatocytes and Target cells
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.*
B12 Deficiency: also known as
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.
Pancreatitis: (B12 deficiency)
inflammation of the pancreas decreases release of intrinsic factor.*
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
Schilling Test, ALL 3 STAGES DECREASE EXCRETION
Terminal Ileum , Disease (Crohn's)