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Haematology > Vitamin B12 & Folate Deficiency > Flashcards

Vitamin B12 & Folate Deficiency Flashcards

1
Q

Define Vitamin B12 Deficiency?

A

Having insufficient vitamin B12 to meet demands

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2
Q

What is B12 found in?

A

B12 is found in meat and animal protein foods

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3
Q

Where does Absorption of Vitamin B12 occur?

A

In the terminal ileum and requires intrinsic factor

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4
Q

Where is Intrinsic Factor produced?

A

By gastric parietal cells

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5
Q

What is Pernicious Anaemia?

A

It is an autoimmune condition involving gastritis, atrophy of all layers of the body and fundus of the stomach and loss of normal gastric glands, parietal and chief cells

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6
Q

What does Pernicious Anaemia lead to?

A

Lack of intrinsic factor

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7
Q

What does Pernicious Anaemia account for?

A

80% of megaloblastic anaemia due to impaired Vitamin B12 absorption

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8
Q

What are the gastric causes of Vitamin B12 Deficiency?

A

Gastrectomy

Atrophic gastritis

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9
Q

What are the intestinal causes of Vitamin B12 Deficiency?

A

Malabsorption
Ileal resection
Crohn’s affecting the terminal ileum, tropical sprue

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10
Q

What drugs can cause Vitamin B12 Deficiency?

A

Colchicine

Metformin

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11
Q

What is the most common cause of Vitamin B12 Deficiency?

A

Inadequate intake (e.g. vegan)

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12
Q

What is the epidemiology of Vitamin B12 Deficiency?

A

Peak age = 60 yrs

Vegans have a higher risk of dietary Vitamin B12 Deficiency

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13
Q

What are the presenting symptoms of Vitamin B12 Deficiency?

A 
Typical Anaemia symptoms 
Fatigue 
Lethargy
Dyspnoea 
Faintness 
Palpitations 
Headache 
Neurological symptoms
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14
Q

What are the neurological symptoms of Vitamin B12 Deficiency?

A

Paraesthesia
Numbness
Cognitive changes
Visual disturbances

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15
Q

What are the signs of Vitamin B12 Deficiency?

A 
Pallor
Heart Failure (can occur with severe anaemia)
Glossitis 
Angular stomatitis 
Neuropsychiatric signs 
Neurological signs
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16
Q

What are the Neuropsychiatric signs of Vitamin B12 Deficiency?

A

Irritability
Dementia
Depression

17
Q

What are the Neurologial signs of Vitamin B12 Deficiency?

A

Subacute combined degeneration of the spinal cord

Peripheral neuropathy

18
Q

What are the general investigations of Vitamin B12 Deficiency?

A

There is NO gold standard for diagnosing Vitamin B12 Deficiency
Measurement of serum B12 is not very accurate or reliable
Other new tests: plasma total homocysteine, plasma methylmalonic acid, holotranscobalamin

19
Q

What do you look for on a FBC and Blood Film for Vitamin B12 Deficiency?

A

Hypersegmented neutrophils
Oval macrocytes
Circulating megaloblasts

20
Q

What tests do you do for Pernicious Anaemia for Vitamin B12 Deficiency?

A

Anti-intrinsic factor antibodies
Anti-parietal cell antibodies
Schilling Test

Haematology (24 decks)

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