This document discusses vitamin B12 deficiency and pernicious anemia. It notes that vitamin B12 deficiency commonly causes macrocytic anemia, particularly in older adults. Pernicious anemia, where antibodies block intrinsic factor and vitamin B12 absorption, is a common cause. Symptoms include mouth burning, glossitis, and angular cheilitis. Diagnosis involves blood tests of vitamin B12, methylmalonic acid, and homocysteine levels. Treatment is weekly intramuscular vitamin B12 injections for 4-6 weeks, followed by monthly injections, though oral supplements can also be effective.

1. KAUSTUBHA P
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IV BDS

2.  Common cause –macrocytic anaemia
 Occurs frequently in elders (20%)
 Potentially serious
 Perticularly a form of neuropsychiatric and
hematologic condition

3.  Cause of deficiency
Food cobalamin malabsorption

4.  Pernicious anaemia(15-20%)

5.  Insfficient dietary intake /malabsorption

6.  Magaloblastic anaemia is a autoimmunine
disease resulting from autoantibodies
directed against intrinsic factor.

7.  Vitamin B12 is necessary for the formation
of RBCs.
 It is common in Celtic and Scandinavian
descent(having average rate of diagnosis at
60 years).

8.  Deficiency of intrinsic factor may result in chronic
gastritis and surgical removal of the stomach.

10.  Burning sensation in the tongue, lips buccal mucosa
and other mucosal sites.
 Tongue and mucosa (smooth patchy areas of
erythema)
 Dysphagia and taste alterations are reported.
 Atrophic glossitis.
 Angular cheilitis.

11.  Measurement of serum vitamin B12 levels (normal or
abnormal)
 50% of the patients have normal vitamin B12 levels.
 More sensitive methods –serum methylmalonic acid
and homocysteine levels which are increased in early
vitamin B12 deficiency.
 Schilling’s test-
radioactive cyanocobalamine is given orally
which increases urine radioactivity
thereby measuring cyanocobalamine absorption.

12. * Haemoglobin Decreased, very low
*MCV Increased ,> 120fL
*erythrocyte
count
Low for degree of anaemia
*Blood film > Oval macrocytosis
>poikilocytosis
>red cell fragmentation
>neutrophil hypersegmentation
*reticulocyte
count
Low for degree of anaemia

13. *Leucocyte count Low or normal
*Platlet count Low or normal
*Bone marrow >increased cellularity
>giant metamylocytes
>dysplastic megakaryocytes
>pathologic non-ring sideroblasts
*serum ferritin elevated
*plasma lactate dehydrogenase elevated

14.  WEEKLY-
Intramuscular 1000mg -VitB12->4-6 weeks.
followed by 1000mg /week indefenitely.
 For VitB12 deficiency states oral Vit B12 supplements are
safe and effective.
 For short term hematological and neurological
responses,
2000mg vitB12 daily and 1000mg vit B12 daily initially
and thereafter weekly and later monthly has shown to
be as effective as intramuscular administration.

15.  Even when intrinsic factor is not present
 Even when there are other diseases which affect the
absorption sites of the terminal ileum
 The oral therapy remains effective.

16.  Burkit’s Oral medicine-Eleventh edition
 Davidson’s Principles and Practice of General
Medicine-22 edition
 Hutchingson’s Clinical Methods-23 edition
 Kumar and Clark’s Clinical Medicine-Seventh edition