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Rahmawati Minhajat
Tutik Harjianti
A. Fachruddin B
Deficiency of Cyanocobalamin
Deficiency Cyanocobalamin
An important sign :
1. macrocytic Anemia
3. Level of Vit B12 <100 pg/ ml
sign
Macrocytic
Normocytic
Division of Hematology & Medical Oncology Dept. of Internal Medicine
The Cause
1. Deficiency vit B12 (diet)
2. The decrease production of intrinsic factor
(Anemia perniciosa, post-gastrectomy)
2. The decrease absorbtion of vit B12 at the ileum
(Post-op, Crohn ds)
3. Helmynthyasis (tape-worm)
4. Deficiency Transcobalamin II
Physiology
Vit B12 come in from IT binding with intrinsic
factor (made from parietal mucosa gaster cell)
abs in ileum terminal by spesific receptor
come in to the plasma liver .
There are 3 protein transporter in the plasma :
Trans-cobalamin I, II & III (by leukocyte). Only
Trans-cobalamin II that can transport vit B12
into the cell.
Phatogenesis
Hepar consist 2.000 5.000 ug vit B12
Need : 3 5 ug / hari
Example :
Anemia Perniciosa
Often cause defs B12
Abnormality Auto-Imun herediter
Seldom show before 35 years old
Scandinavia / Eropa Utara
A black skin teenager, a hispanic woman
Anemia Perniciosa
Clinic illustration :
Likely anemia caused by defs vit B12,
- Gastritis atrophic
- Abnormal Auto-Imun ( rheumatoid arthritis
Graves disease, defs IgA )
- After several years some patient
Gastritis Atrophic => Carcinoma Gaster
CLINIC MANIFESTATION OF
DEFS. VIT B12
Megaloblastic anemia
Lab. Abnormal
1. Megaloblastic Anemia
2. MCV between 110 140 fl (increase)
at some patients : MCV normal
Blood Perifer
4.Morfologi eritrosit is abnormal
Likely Hemolytic Anemia
5. Hypersegmentation of neutrophyls
6. Decreased Reticulocyte amount
Diagnosis
1. Level of vit B12 serum is low
( normal : 150-350 pg / mL )
2. Schilling test ( for dx A Perniciosa /
the decrease absorpsi vit B12 oral )
THERAPY
*
Respons Therapy
Reticulocytosis 5 7 days.
Abnormalitas hematologic disappear after 2
months.