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Vitamin B12 Deficiency Anemia


Step 1: View clinicals

A 35 year old woman presents with a tingling sensation in both hands and feet for 2 months, in association with worsening numbness. No other symptoms were present. Her medical and surgical histories are unremarkable, while her family history is only significant for a brother who died in childhood from Menkes disease. Currently, she is not on any medications. She is a strict vegan, and does not drink or smoke. A complete blood count is significant for a Hb of 9.3 g/dL, erythrocyte count of 3.1× 10^12/L, and a MCV of 126 fL. A fasting plasma glucose level is 84 mg/dL.

Step 2: Order all relevant investigations

Peripheral Blood Film

The peripheral blood film demonstrates marked macrocytosis and anisopoikilocytosis, along with some hypersegmented neutrophils.

MRI Cervical & Thoracic Spine

The posterior columns of the cervical and upper thoracic spinal cord show bilateral symmetrical hyperintensity in T2-weighted images, and hypointensity in the T1-weighted films.

Nerve Conduction Studies

Nerve conduction studies of both the upper and lower limbs reveal no abnormalities.

Serum Vitamin B12 + Folate + Copper

Vitamin B12: 110 pg/mL (200-800) Folate: 22 ng/mL (2-20) Copper: 117 μg/dL (80-155)

Step 3: Select appropriate management

Parenteral Copper
Parenteral Vitamin B12
Folate Supplementation
Vitamin B12 Fortified Foods

Score: ★★☆