Vitamin B-12

Deficiency

Bustamante, Jon Rubert

Gamutan, Ranillo Jr.
 Vitamin B12-
Deficiency
• Serum Methylmalonic acid levels
 elevated
 a dicarboxylic acid that is a C-
methylated derivative of malonate and
The coenzyme A linked form of
methylmalonic acid, methylmalonyl-CoA, is
converted into succinyl-
CoA by methylmalonyl-CoA mutase, in a
reaction that requires vitamin B12 as a
Diagnos
cofactor
 Vitamin B12-
Deficiency
• Serum B12 levels are low
• Serum Homocysteine --
elevated

Diagnos
 Vitamin B12-
Deficiency
Intrinsic factor antibody Test
a more useful, easier test
(+) results: indicates the presence of
antibodies that bind the Vit. B12—intrinsic
factor complex and prevent it from binding
to receptors in the ileum, thus preventing
its absorption.
 not specific for pernicious anemia
alone, but can aid in the diagnosis
Diagnos
 Vitamin B12-
• Schilling test Deficiency
 classic method of determining the
cause of
the vitamin B12 deficiency
The patient receives a small oral dose
of radioactive Vit. B12 followed in a few
hrs by a large, nonradioactive parenteral
dose of Vit. B12 (which aids in renal
excretion of the radioactive dose)
If oral vitamin is absorbed, more than 8%
Diagnos
 Vitamin B12-
Deficiency
Results:
If no radioactivity is present in the urine (the
radioactive Vit. B12 stays within the GI tract) – cause:
GI malabsorption of the vitamin B12
Conversely, if radioactivity is detected in the urine –
cause: not ileal disease or pernicious anemia.

 Oral radioactive Vit. B12, added with intrinsic

factor:
If radioactivity is now detected in the urine (the Vit.
B12 was absorbed from the GI tract in the presence of
intrinsic factor) = Diagnosis: Pernicious anemia
Diagnos
 Vitamin B12-
Deficiency
• Vit. B12 deficiency is treated by Vit. B12
replacement.
• Oral supplements through vitamins or fortified soy
milk.
• Defective absorption or absence of intrinsic factor:
replacement is by monthly IM injections of Vit. B12,
usually at dose of 1000μg.

--reticulocyte count rises within 1 week, blood

counts are all normal. Tongue improves in several days.
Neurologic manifestations require more time for
recovery.If there is severe neuropathy, patient may
Manage
never recover fully.
 Vitamin B12-
Deficiency
• Inspection of the skin and mucous membranes.
• Assess the patient’s gait and stability and the
need for assistive devices to ensure safety
when position sense, coordination and gait are
affected.
• Advise patient to prepare bland, soft foods and
to eat small amounts frequently.
• Patient s must also be taught about the
chronicity of their disorder and the necessity
for monthly Vit. B12 injections even in the
Manage
absence of symptoms.