Vitamin B12 and Folate Deficiency
What?
Vitamin B12 and folic acid (folate) are B complex vitamins necessary for normal red blood cell (RBC-erythrocyte) formation, tissue and cell repair and DNA synthesis . A B12 and / or folate deficiency reflects long-term chronic deficiency of one or both of these vitamins. The body stores 3-5 years of vitamin B12 and folate folate for 3-5 years, deficiencies in adults and the occurrence of related symptoms may take months and years. However, babies and children will show signs of deficiency more quickly because they do not have plenty of spare stores.
Over time, deficiency of B12 or folate can lead to macrocytic anemia, which is characterized by fewer but larger red blood cell production and reduced ability to carry oxygen. Patients are weak due to anemia. They may experience dizziness and shortness of breath. Vitamin B12 deficiency can also lead to varying degrees of neuropathy. Neuropathy is nerve damage that can cause tingling and numbness in the hands and legs of the patient, blurred consciousness, irritability and severe mental disorders ranging from dementia to severe dementia.
Pregnant women require increased amounts of folate to develop the fetus correctly. If a woman has folate deficiency before pregnancy , the deficiency will increase during pregnancy and may cause premature birth and birth defects such as spina bifida and neural tube in the child.
symptoms
Findings related to B12 and folate deficiency are generally not specific and not clear. The findings are associated with the resulting macrocytic anemia, nerve involvement, and gastrointestinal changes. Patients with early stage deficiency can be diagnosed without any obvious findings. Other patients may experience a variety of mild to severe disorders, which may include:
Blur of Consciousness
Paranoia
Diarrhea
Dizziness
Exhaustion, weakness
Anorexia
Absorption disorder
Paleness
Fast heart beats
Shortness of breath
Bitterness in tongue and mouth
Tingling, numbness and / or burning sensation in feet, hands, arms and legs (with B12)
Reasons
B12 and folate deficiency may be due to inadequate uptake, inadequate absorption, increased losses or requirement. Folate is found in green leafy plants, citrus fruits, legumes, yeasts and doped grains. B12 is found in red meat, fish, poultry, milk, eggs, and added cereals. Deficiency due to insufficient B12 intake is rare, but can be seen in full vegetarians (those who do not consume any animal products) and breastfed children.
Gastric acid deficiency required to separate vitamin B12 from dietary protein may also cause B12 deficiency. This is the most common cause in the elderly and in people taking drugs that suppress gastric acid production. The deficiency may be due to a lack of intrinsic factor produced by gastric wall ( parietal ) cells that binds B12 before absorption in the intestines. An autoimmune disorder called pernicious anemia causes damage to the gastric wall cells, leading to a decrease in intrinsic factor.
B12 and folate deficiency may occur as a result of diseases and abnormal conditions that cause general absorption disorders such as celiac disease , inflammation of the intestines and malabsorption caused by intolerance to cereal products, bacterial growth in the stomach and intestines, surgical removal of parietal cells of the stomach or part of the intestines.
Chronic disorders such as liver or kidney disease and alcoholism , drugs such as phenytoin , metformin (treatment of diabetes) or methotrexate (treatment of an arthritis) can lead to decreased B12 or folate levels.
All pregnant women require large amounts of folate for proper development of the fetus. Any deficiency present before pregnancy will increase during pregnancy .
tests
During routine complete blood count testing , anemia and large red blood cells (RBC) in vitamin B12 or folate deficiency are often detected. Laboratory tests are used to determine a deficiency, severity, and underlying cause and to monitor the effectiveness of treatment.
Laboratory Tests
B12 and folate deficiency are frequently asked for diagnosis and follow-up :
B12 - If it is low, there is a deficiency, but the abortion cannot determine the cause. Even if normal, folate deficiency may still be present. You may be asked to follow the effectiveness of treatment.
Complete blood count . It is a group of tests that are routinely required to screen for blood cell abnormalities. Determines cell types, quantities and characteristics. In both B12 and folate deficiency anemia, hemoglobin levels may decrease and red blood cells (RBC) are abnormally enlarged (macrocytic or megaloblastic). White blood cells (leukocytes-WBC) and platelets may also decrease.
Folate . Folate in serum or red blood cell can be tested. Some researchers believe that folate in the red blood cell is more clinically relevant. If either of them is low, this indicates a deficiency. If normal, there may still be a B12 deficiency. It may be desirable to monitor the effectiveness of treatment.
Rarely used tests to diagnose B12 and folate deficiency:
Methylmalonic Acid (MMA) . It is sometimes desirable to help determine B12 deficiency, mildly or early.
Homocysteine . Occasionally requested. It may increase in both B12 and folate deficiency.
Desired tests to help determine the cause of B12 deficiency:
Schilling Test - It was often desirable to confirm the diagnosis of pernicious anemia . This test is usually no longer performed.
It interferes with the binding of Intrinsic Factor Binding Antibody-B12. It may be present in pernicious anemia. It is a special test which is not usually done in routine.
Intrinsic Factor Blocker A protein that inhibits the binding of Antibody-B12 to the intrinsic factor. It is present in more than 50% of all pernicious anemia patients.
Parietal Cell Antibody - It is an antibody against parietal cells that form intrinsic factor. It is an antibody that is found in a large percentage of patients with pernicious anemia and can also be seen in other disorders.
Treatment
Treatment of B12 and folate deficiencies often requires long-term or lifelong supplementation. Those who suffer from intrinsic factor deficiency or general malnutrition require B12 injections. Folate / folic acid is an oral additive. Doctors recommend that women considering childbearing receive folate supplements during or before pregnancy to ensure that they have adequate stock for the normal development of the fetus.
If the patient has both B12 and folate deficiency, he will need to supplement both. If the patient with B12 deficiency receives only folic acid supplements, the underlying neuropathy (nerve damage) caused by B12 deficiency will persist, although macrocytic anemia can pass. With appropriate treatment, the symptoms of the disease must pass, while nerve damage may not completely return.
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