Condition Info - BotMed Application

ConditionName

Vitamin B12 deficiency (Pernicious Anemia)

ConditionDescription

Symptoms

Neurological problems (peripheral);
Dementia;
Bilateral spastic paralysis of arms.

PhysicalFindings

Dorsal columns and corticospinal tract affected:
Bilateral loss of vibration, proprioception, fine touch;
Glossitis (including pain, swelling, tenderness, and loss of papillae of the tongue)

ClinicalTests

Megaloblastic anemia ↑MCV;
Hyperpigmented neutrophils;
B12 level;

↑LDH; ↑indirect bilirubin;
↑Methylmalonic acid;
↑Homocysteine;
Schain’s test – we don’t use it. Is it any problem with intrinsic factor;

Same symptoms except hyperpigmented neutrophils:
R/O alcoholism, liver disease (AST/ALT/bilirubin);
R/O hypothyroid (TSH);
R/O: pernicious anemia (Anti-intrinsic factor antibodies);
R/O: MS;

RiskFactors

Autoimmune gastritis – AB against own gastric parietal cells;
Pancreatic deficiency;
Cystic fibrosis;
Malabsorption;
Vegetarian/vegan diet;
Crohn’s disease;
Diphyllobothrium latum (from sushi) – undercook fish;
Alcoholism;

IsRedFlag

IsNPLEX

Consequence

Dementia in elderly;
Anxiety;

ProgressionFromCondition

Overgrowth of bacteria in part of the small intestine
Impaired absorption (malabsorption disorders such as celiac disease or certain pancreatic disorders)
Inflammatory bowel disease affecting the last part of the small intestine
Fish tapeworm infection
Advanced HIV infection
Bariatric surgery for weight loss
Surgery that removes the part of the small intestine where vitamin B12 is absorbed
Medications such as antacids and metformin (used to treat diabetes)
Repeated recreational exposure to nitrous oxide (laughing gas)
Lack of intrinsic factor
Decreased stomach acidity (common among older people)

TreatmentOptions

Shot IM B12; dietary B12;

PharmOptions

WebLink

https://www.merckmanuals.com/en-ca/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-b12-deficiency