A 61yo man underwent a surgery in which ileal resection had been done. He complains of
fatigue, headache, and heart racing. Labs: MCV=108fL, Hgb=8.9g/dL. What is the most likely dx?
a. Vit B12 def
b. Iron def
c. Folate def
d. Hemolytic anemia
e. Anemia of chronic disease
answer: A
B12 (cobalamin)
• binds to intrinsic factor (IF) secreted by gastric parietal cells
• absorbed in terminal ileum
• total body stores sufficient for 3-4 yr
inv of choice for b12 anemia? schilling test.......stage 1 >10% of radio labelled b12 should pass into urine if it normally gets absorbed in the ileum, otherwise will be less than <10% ....... stage 2, add oral intrinsic factor.........if good absorption > gastric cause .....still bad absorption > intestinal cause e.g. malabsorption
No comments:
Post a Comment