USMLE (Fach) / Hematology and Oncology (Lektion)

Vorderseite Vitamin B12 (cobalamin) deficiency
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Causes:- Insufficient intake (eg, veganism)- Malabsorption (eg, Crohn disease)- Pernicious anemia- Diphyllobothrium latum (fish tapeworm)- Gastrectomy

Findings:- ↑ homocysteine, ↑ methylmalonic acid- Neurologic symptoms: reversible dementia, subacute combined degeneration (due to involvement of B12 in fatty acid pathways and myelin synthesis): spinocerebellar tract, lateral corticospinal tract, dorsal column dysfunction.- Historically diagnosed with the Schilling test, a 4-stage test that determines if the cause is dietary insufficiency vs malabsorption.- Anemia 2° to insufficient intake may take several years to develop due to liver's ability to store B12 (as opposed to folate deficiency).

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