objectives body stores and daily requirements of vitamin b12 and folate absorption of vitamin b12...
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Objectives • Body stores and daily requirements of vitamin B12
and folate
• Absorption of vitamin B12 and folate from the gut
• Causes of vitamin B12 and folate deficiency
• Hematological consequences of vitamin B12 and folate deficiency
• Neurological sequelae of vitamin B12 deficiency
• Diagnosis and management of megaloblastic anemia
• Diagnosis and management of Pernicious Anemia
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Requirements for Red Blood Cell Production
• Erythropoeitin• Proteins, required for globin synthesis• Iron • Vitamin B12 and folic acid• Vitamin B6 • Vitamin C • Thyroid hormones, estrogens and androgens
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Vitamin B 12 and Folate
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Macrocytic anemia with hypersegmented neutrophil
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Macro-ovalocyte in megaloblastic anemia
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Macro-ovalocyte in megaloblastic anemia
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Megaloblastic Anemia – Bone Marrow
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Bone marrow - megaloblasts
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Important for DNA synthesis, nervous tissue and fat metabolism in the liver
an intermediate of the citric acid cycle, porphyrin synthesis
(Heme synthesis)
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Absorption and transport of vitamin B12
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Absorption and transport of vitamin B12
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B12 /
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• Early graying of hair
• Blue eyes
Pernicious Anemia (PA)
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Pernicious Anemia
• Red beefy tongue
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Pernicious Anemia
• Vitiligo
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Normal Gastric atrophy
PA
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Atrophic Gastritis
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The patient was a 45 year old woman. She had a swollen tender tongue, parasthesias of both feet and hands, decreased proprioception and vibratory sensation, ataxia and leg weakness.
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Subacute Combined Degeneration of Spinal Cord
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CBC:
HbHctMCV MCHRDW WBC Plt
106 g/l32%125 f35.8 pg14.9%3.2100
(120-160)(35-46)(80-100)(27-33)(9-15)(4.8-10.8)(150-400
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Reticcount
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