Vitamin B 12 #2

decreased serum cortisol

Addison Disease

-Intrinsic factor deficiency -surgical removal of terminal ileum -intrinstic dz of terminal ileum (chrons, celiac, lake fish tapeworms, bacteria) -meds

impaired absorption of vitamin b 12

-characteristics of PA -inflammation of lymphocytes within the gastric walls -degeneration of parietal cells and replacement with globlet cells what is this phenomenon called?

intestinal metaplasia

principal abnormailty in perncious anemia is the absence of _____ _____

intrinsic factor

what skin color can patients present with?

lemon yellow skin color

low wbc

leukopenia

following the megaoblasts release into the circulation they are then known as

macrocytes

why is the MCV high

macrocytic anemia

-positive family history of perncious anemia -Scandinaviean or Celtic descent -medical history of an autoimmune disease (type 1 dm, graves, hasimotos, addisons)

major risk factors of vitamin b 12 deficiency

abnormal development of RBC results in premature cell death and phagocytosis within the bone marrow. this is known as

megaloblastic anemia

in the bone marrow these large immature RBC are known as

megaloblasts

a deficiency of vitamin b 12 causes abnormal methylation of the protein compound of myelin and causes the synthesis of abnormal myelin. this results in myelin degeneration and produces _____ _____

neurological complications

when the vitamin is deficient what occurs?

nuclear maturation and cell division of rapidly proliferating RBC fail to occur within the bone marrow (megaloblastic anemia)

despite DNA synthesis in developing RBC of people who are b 12 deficient RNA process occurs at a normal rate which results in disparity between ____ and ____

nucleus and cytoplasm

bone marrow biopsy will show

RBC hyper cellularity megaloblasts

demylenation of the peripheral nerves causes what in the hands and feet?

paraesthesia

abnormal condition characterized by an elaborate, suspicious system of thinking that is usually centered on one major theme such as an unfaithful spouse, being poisoned, or being watched by outer space aliens

paranoid

-macrocytosis -ansiocytosis -polikocytosis -hypersegmented neutrophils -giant platelets -normal lymph and plasma where will this be found?

peripheral blood smear

most common cause of vitamin b 12 deficiency anemia is known as____ ____

pernicious anemia

-surgical removal of stomach -chronic gastritis -use of PPT -chronic pancreatic dz

poor utilization/seperation

why is it reasonable to test the serum folic acid concentration in a patient who is suspected of having it b 12 deficiency

present with similar lab findings need to differentiate

what is alchlorhydira?

production of hydrochloric acid in gastric secretions is low in the stomach

the effectiveness of B12 replacement is measured by an increasing ____ count

reticulocyte count

______/______ descents are at a higher risk of developing vitamin b 12 deficiency

scandiavians/celtics

-poor sensory vibration -positive babinski -impaired senses -subnormal deep tendon reflexs what does this indicate?

spinal cord demylenation

-anorexia with weight loss -burning or soreness of the tongue -nausea and vomiting -paraestheisa -symptoms that mimic Alzheimer's Dz -delusions, hallucinations, paranoias -spinal cord damage that can result in abdominal ridgity and severe pain, urinary retention, uncoordinated movements

symptoms of vitamin b 12

where is vitamin b 12 absorbed? where is it stored?

terminal ileum liver

low platelets

thrombocytopenia

vitamin b12 promotes synthesis of (3)

thymindine synthase function DNA synthesis normal development on nucleus in cells

need to obtain family history because genetically transmitted deficiencies of ______ occur in families as an auto recessive gene

transcobalamin II

lack of serum insulin

type 1 DM

vitamin b 12 deficency is commonly seen in

vegetarians, alcoholics

demyelination of the spinal cord results in loss of ____ senses in the arms and legs and eventually ataxia.

vibratory

-fatigue -weakness -lightheadedness are common symptoms of

vitamin b 12 deficency

-abnormally large -flimsy cell membranes -oval shape -highly succeptible to intramedullary hemolysis characteristics of

vitamin b 12 deficency RBC

-sore tongue -poor appetite -diarrhea

vitamin b 12 deficency compliants

-lemon waxy looking skin -yellowing of the eyes -premature grey hair -low grade fever -red smooth beefy tongue -dyspnea -tachycardia -retinal hemmorages -hepatomeagly -splenomeagly -pedal edema

vitamin b 12 deficency symptoms

how do you treat vitamin b 12 deficiency?

vitamin b 12 replacement

are peripheral nerves usually affected first? what does the patient complain of?

YES, paraesthia in hands and feet

congenital enzyme defects that result in impaired deoxyadenosylcobalamine or methylcoblamin synthesis

abnomrla utilization of vitamin b 12

congenital deficiency of plasma protein carrier transcobalamin II will lead to

abnormal plasma transport of vitamin b 12

signs of pedal edema indicate

anemia is severe and HF has developed

reticulocytes are low, what type of anemia?

aplastic

why is the systolic border best heard at the right sternal border?

bc hematocrit is less than 20%

why is achyloridia reasonable to find in patients with pernicious anemia?

because there is a commonly problems with the stomach lining in patients because of improper neutrition and alcohol

the posterior columns of the spinal cord degenerate when the deficency becomes more severe. what happens as a result?

cerebral function is altered can cause dementia and depression

what meds can cause impaired absorption of vitamin b 12?

cholestyramine neomyocin metformin phenoformin colchine

why is there a mild loss of mental status?

damage to the myelin sheath

persistant aberrant beliefs or perceptions held inviolable by a person despite evidence that refutes them

delusions

-strict vegetarian diet -chronic alcoholism what type?

dietary insufficiency of b12

use of ___ ___ ___ ___ can lead to decreased b 12 levels, may play a role in vitamin b 12 deficiency

gastric acid blocking agents

increased serum thyroxine

graves disease

abnormal sensory perceptions that can occur in any of the senses, do not result from an external stimulus and occur in the walking state

hallucinations

decrease serum thyroxine

hasimotos thyroiditis

severe anemia may present with

heart failure and retinal hemorrhages

elevated serum biliruben indicates

hemolysis of RBC

as a result of significant degree of cell death that occurs from vitamin b 12 deficiency, serum LDH levels are ____

high

As methylcobalamin, the vitamin serves as a co factor for methionine syntheses in conversion of ______ to _____

homocysteine to methionine

what are reticulocytes?

immature blood cell without a nucleus

if a patient has pernicious anemia, what will the gastric evaluation present?

-absence of hydrochloric acid -lymphocytes in the walls of the stomach

vitamin b 12 caused by 5 things

-inadequate intake -impaired absorption -impaired plasma transport -poor utilization/serperation

what is vitamin b 12 essential for?

-RBC production -nervous system conduction -DNA synthesis

If the father of an unborn child has a single defective gene/mutation for transcobalamin II deficiency and the mother has two normal genes, what is the probability that their unborn child will be transcobalamin II deficient?

0%

If both the father and mother of an unborn child each have a single defective gene/mutation for transcobalamin II deficiency, what is the proba- bility that their unborn child will be transcobalamin II deficient

25%

how many plasma proteins transport b 12?

3

human body stores how many years of vitamin b 12? what does this cause?

3-5 years worth signs of deficiency will occur slowly in adults and quicker in children because they have less storage

nervous system conditions are reversible with B 12 replacement only if the treatment occurs within ___ months of onset

6

which transcobalamin is capable of transporting vitamin b 12 into cells for use?

II

if megaloblastic anemia results from the lack of dietary intake the condition may be initially treated with _____ injections and then maintained with oral b 12

IM

what is a specific test for vitamin b 12? will it be high or low with vitamin b 12 deficiency?

MMA (methylmanoic acid) HIGH

serum antibodies to parietal cells and serum antibodies to intrinsic factor POSITIVE indicative of what?

PERNCIOUS ANEMIA

Trascobalamins I and II are secreted by

WBC