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==Overview==
==Overview==
==History and Symptoms==
==History and Symptoms==
The following points should be noted in history:
* Patient age: MCV is higher in neonates and infants.
* Medical history
* Alcohol use
* Medications (eg, anticonvulsants, zidovudine, immunosuppressive agents) – 51 (35 percent)
* Congenital heart disease – 20 (14 percent)
* Down syndrome – 12 (8 percent)
* Reticulocytosis – 11 (8 percent)
* Bone marrow failure/dysplasia – 6 (4 percent)
* Liver disease, thyroid disease [21,47]
* Hemolytic anemias with reticulocytosis and myelodysplastic syndromes (MDS)
* Macrocytosis is a common feature of MDS, especially in older adults
Patients usally show the following symptoms: 
* B12 deficiency causes neurologic dysfunction.
* Anemia symptoms such as fatigue, dyspnea, lightheadedess, and anorexia occur


*The major manifestations of Folate or B12 deficiency are related to the anemia and gastrointestinal dysfunction.  Only B12 deficiency causes neurologic dysfunction. Constitutional symptoms related to anemia such as fatigue, dyspnea, lightheadedess, and anorexia occur.  High output cardiac failure and angina are also consequences.
* High output cardiac failure  
 
* Angina  
Symptoms mostly related to GI mucosal abnormalities.  Tend to be worse in folate rather than B12 deficiency. [[Diarrhea]], [[cheilosis]] and [[glossitis]] can be noted.
* [[Diarrhea]]
 
* C[[cheilosis|heilosis]]  
*The classic picture of B12 deficiency is subacute combined degeneration of the dorsal columns. Specific for B12 deficiency, the patient will present with a broad based gait, ataxic, irritable, forgetful with numbness or paresthesias.  Rhomberg and Babinski’s can be noted.  Dementia may progress to frank “Megaloblastic Madness”.  Remember, hematological abnormalities can occur without neurologic manifestations in B12 deficiency.
* G[[glossitis|lossitis]]  
* Subacute combined degeneration of the dorsal columns.  
* Broad based gait
* Ataxic
* Numbness or paresthesias.   
* Rhomberg and Babinski’s sign.   
* Dementia may progress to frank “Megaloblastic Madness”


==References==
==References==

Revision as of 19:12, 5 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

History and Symptoms

The following points should be noted in history:

  • Patient age: MCV is higher in neonates and infants.
  • Medical history
  • Alcohol use
  • Medications (eg, anticonvulsants, zidovudine, immunosuppressive agents) – 51 (35 percent)
  • Congenital heart disease – 20 (14 percent)
  • Down syndrome – 12 (8 percent)
  • Reticulocytosis – 11 (8 percent)
  • Bone marrow failure/dysplasia – 6 (4 percent)
  • Liver disease, thyroid disease [21,47]
  • Hemolytic anemias with reticulocytosis and myelodysplastic syndromes (MDS)
  • Macrocytosis is a common feature of MDS, especially in older adults

Patients usally show the following symptoms:

  • B12 deficiency causes neurologic dysfunction.
  • Anemia symptoms such as fatigue, dyspnea, lightheadedess, and anorexia occur
  • High output cardiac failure
  • Angina
  • Diarrhea
  • Cheilosis
  • Glossitis
  • Subacute combined degeneration of the dorsal columns.
  • Broad based gait
  • Ataxic
  • Numbness or paresthesias.
  • Rhomberg and Babinski’s sign.
  • Dementia may progress to frank “Megaloblastic Madness”

References

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