Vitamin B12 Deficiency;

Abstract

Objectives: To determine the frequency of neurological manifestations of vitamin B12deficiency and to observe the reversibility of the symptoms after the therapy. Study Design: Descriptivestudy. Study Design: Descriptive study. Setting: Medicine Department of Bolan Medical Complex HospitalQuetta. Period: One year that is from January 2012 to December 2012. Methodology: 46 patients presentedto various OPDS of B.M.C.H.. The inclusion criteria for the patients to be studied were: Anemia, Neurologicalcomplaints. Results: Out of 46 patients 26(56%) were males and 20(43%) were the females with a meanage of (40) years.32 (69%) belonged to the rural areas. 45(97%) had mixed diets whereas only one 1(2.1%)young non Muslim was found to be pure vegetarian.32 (69%) patients presented with hematological aswell as neurological complaints. 23(30%) had pancytopenia and 9(19.5%) had bicytopenia. 14(30%)presented with neurological complaints only as sacd 6 (13%), ataxia 8 (17%), sensorimotor neuropathies36 (78%) and dementia 2 (4.3%). In signs glossitis was found in 6(13%), jaundice in 22 (47%), pallor in32 (69%) proximal myopathy in 12 (26%) out of which 6 (13%) had shoulder girdle and 8 (17%) pelvicgirdle myopathy. Impaired position sense was found in 18 (39%) patients and vibration sense in 21(45%)patients. other signs were pigmentation 2(4.3%) hypotonia in 6(13%) Spasticity in 2(4.3%) and Upgoingplantars in 6(13%) patients. Lhermittes sign could be elicited in only 2(4.3%) patients Optic neuritis andoptic atrophy was found in 4(8.6%) patients who came with paraplegia and marked anemia. Rhombergssign was positive in 8(17.3%) who came with clumsiness of gait. Hemoglobin (Hb %) was found to be lowin 32(69%) with a mean of 7.2gm%.pancytopenia (anemia+leucopenia+thrombocytopenia) was found in23(50%) of patients whereas bicytopenia was found only in 9(19.5%) of patients. Hypersegmented W.B.Cwere very carefully looked for and were found in 20(43%) of cases. ovalomegaloblasts were found in 32(69%) of cases .both findings of ovalomegaloblasts and hypersegmented w.b.cs were found in 20 (43%).in the rest 14 (30%) the blood investigations were found to be normal. The next investigation in all patientswas serum B12 estimation, It was found that levels below 200pg/ml were found in 95% cases where only2(4.3%) patients came with levels slightly above 205pg/ml and 210pg/ml. the response to therapy wasrecorded as reversible and irreversible. the irreversible features were sacd in 6 (13%), optic atrophy in2 (4.3%), and dementia in 2 (4.3%) patients. the partially reversible features were myelopathy 10 (21%)numbness and paraesthesias 30 (65%) optic neuritis inn 2 (4.3%) patients were assessed on a durationof 24 weeks. partially reversible features were ataxia, in 6 (13%) patients myelopathy in 2 (4.3%) patientsdementia in 2 (4.3%) patients and paraesthesias and numbness in 6 (13%) patients over a period of 24weeks. Conclusion: It is concluded from my study that the neuropsychiatric manifestations of vitamin B12deficiency are common among the elderly age group, either with or with out the evidence of anemia.

A Case Report of Cold Agglutinin Disease, Severe B12 Deficiency, and Pernicious Anemia: A Deadly Coincidence

“…It can be mistakenly diagnosed as another cause of thrombotic disease such as thrombocytopenic purpura (TTP), as it did in the case of Osman et al [ 3 ], hence the importance of analyzing vitamin B12 levels in this type of case. Vitamin B12 deficiency has three main etiologies: autoimmune, malabsorption, and dietary insufficiency [ 14 ]. Our case presented had a combination of two: autoimmune secondary to pernicious anemia, which was found during the admission, and dietary insufficiency due to alcoholism.…”