Heme/Onc - Vitamin B12 deficiency, Folate deficiency Flashcards

4658012820	Vitamin B12 deficiency what type of anemia?	macrocytic	0
4658012821	vitamin B12 deficiency B12 plays important role in - incidence increases with-	NEURO function age	1
4658012822	B12 in what foods? (only source)	animal proteins dairy eggs shellfish fish	2
4658012823	cobalamin absorption depends on	adequate diet intake acid-pepsin in stomach pancreatic proteases gastric secretion of intrinsic factor ileum w/ functional cobalamin-IF receptors	3
4658012824	causes of vitamin B12 deficiency	inadequate diet (usually not the issue) malabsorption - pernicious anemia & others other H. pylori chronic pancreatitis zollinger-ellison syndrome HIV hereditary factors drugs	4
4658012825	pernicious anemia	autoimmune destruction of parietal cells --> dec IF ===> malabsorption of B12 may be with other autoimmune d/o - thyroid, addison's vitiligo	5
4658012826	other causes of malabsorption of B12	gastrectomy/gastritis (total/partial, roux-en-Y) ileal resection (abs in terminal ileum) crohn's dz (ileal) fish tapeworm	6
4658012827	hereditary B12 deficiency	transcobalamin deficiency usually presents within few weeks of birth	7
4658012828	drugs that cause B12 deficiency	metformin (put on Ca2+ to avoid) PPIs	8
4658012829	vit B12 def - clinical manifestations	general - glossitis NEURO - peripheral neuropathy (symmetrical, LE) ataxia (vibration, position), weakness PSYCH - irritability, depression, personality changes, memory impairment, dementia skeletal - osteoporosis	9
4658012830	vit B12 def - diagnosis	CBC peripheral blood smear vitamin B12 methylmalonic acid homocysteine lvl	10
4658012831	vit B12 def CBC: mcv peripheral blood smear:	CBC: low Hgb, MCV >100, RDW inc (sizes vary) smear: macroovalocytes, lg oval erythrocytes, hypersegmented neutrophils	11
4658012832	vitamin B12 normal =	>300	12
4658012833	borderline result = if borderline results... what should you do?	200-300 order homocysteine lvl methylmalonic acid lvl	13
4658012834	low = B12 value is consistent with deficiency	<200	14
4658012835	falsely low B12	folate deficiency multiple myeloma pregnancy	15
4658012836	falsely normal B12	chronic liver dz myeloproliferative disorders chronic renal dz	16
4658012837	if you suspect B12 def, what should also be checked for?	folate deficiency	17
4658012838	B12 def methylmalonic acid = homocysteine lvl =	increased increased	18
4658012839	which his increased with BOTH folate and B12 deficiency?	homocystiene lvl	19
4658012840	increased methylmalonic acid can also be found in patients with	chronic renal insufficiency	20
4658012841	methylmalonic acid & homocysteine lvls both normal = both increased =	vit B12 and folate deficiency ruled out B12 deficiency confirmed	21
4658012842	autoimmune destruction of gastric parietal cells	pernicious anemia	22
4658012843	pernicious anemia = increased risk of	gastric carcinoma 3x higher EGD to look for signs of cancer	23
4658012844	pernicious anemia diagnosis	shilling test anti-intrinsic factor antibodies anti-parietal cell antibodies	24
4658012845	HIGHLY confirmatory for diagnosis	anti-IF antibodies***	25
4658012846	shilling test	rarely used today distinguishes IF related malabsorption (location)	26
4658012847	vit B12 deficiency treatment	tx underlying cause if possible vitamin B12 - IM or oral	27
4658012848	B12 IM dose	1 mg IM QD x 7 days, then 1 mg IM weekly x 4 weeks, then 1 mg monthly	28
4658012849	oral B12	1000-2000 mcg/day	29
4658012850	hemoglobin normalizes by	2 months	30
4658012851	neuro sx improve over	3 months max @ 6-12 mo	31
4658012852	B12 screening	no guidelines base on history, PE, risk factors (i.e. bypass)	32
4658012853	where is folate found?	animal products leafy veggies fruits cereal & grains nuts	33
4658012854	folate deficiency most commonly due to	malnutrition poor diet +/or alcoholism (alcohol inhibits abs)	34
4658012855	where is folate stored?	liver stores last 2-4 months	35
4658012856	drugs that can cause folate deficiency	methotrexate phenytoin trimethoprim	36
4658012857	intestinal malabsorption	crohn's sprue	37
4658012858	increased folate requirements	inflammatory dz - psoriasis exfoliative dermatitis RA crohn's	38
4658012859	folate deficiency clinical manifestations	weakness glossitis fatigue weight loss NO neuro sx	39
4658012860	folate deficiency diagnosis	folate level red cell folate homocysteine level	40
4658012861	folate level: red cell folate: homocysteine level:	folate level: inc or dec (short-term reflection) **red cell folate: decreased homocysteine level: increased (methylmelonic acid NOT)	41
4658012862	what is most reliable indicator of folate lvl?	red cell folate	42
4658012863	folate deficiency treatment	tx underlying folic acid	43
4658012864	folic acid dose	1 mg/day 1-4 mo. or until complete hematologic recovery	44
4658012865	IMPORTANT: rule out this BEFORE treating for folic acid	B12 deficiency	45