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Overview :
A patient with vitamin B12 deficiency may show a number of
clinical and laboratory findings.
NOTE: It is important to distinguish those findings
attributable to the vitamin B12 deficiency from those associated with the
underlying cause of the deficiency.
General findings include:
(1) fatigue and general weakness
(2) glossitis
(3) stomatitis
(4) pallor
(5) loss of appetite with weight loss
(6) mild jaundice
(7) loss of central vision
Psychiatric findings may include:
(1) confusion
(2) neurosis
(3) delusions and/or hallucinations
(4) memory loss
(5) dementia
(6) stupor
Neurologic findings (associated with deterioration in the
posterior and lateral columns of the spinal cord)
(1) paresthesias in hands and feet
(2) decreased vibration and position senses (proprioception)
(3) decreased deep tendon reflexes
(4) ataxia with unsteady gait
Laboratory findings may include:
(1) megaloblastic anemia, with elevated MCV
(2) thrombocytopenia and/or neutropenia
(3) elevated serum total bilirubin (due to indirect
bilirubin)
(4) elevated serum LDH
Diagnostic tests:
(1) methylmalonic acid (MMA) in serum or urine
(2) serum vitamin B12
Neurologic changes associated with vitamin B12 deficiency
may occur in the absence of megaloblastic anemia.
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