frank100
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For the pat 10 years a 28 y/o woman has followed a strict diet that prohibits dairy products, meat, fish, and fowl. On routine examination her hematocrit is 30%, and MCV: 122. which of the following is the most appropriate next step i diagnosis?
a) Erythrosite folate determination
b) serun iron and TIBC determinantion
c) serum thyroid hormone determinantion
d) BUN determinantion
e) serum vitamin B12 determinantion
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| mazinger
Forum Guru
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If I have to pick between A and E, I pick E..
B12 levels all the way..
You need B12 in order to propperly use folate acid deposits (If my memmory doesnt fail the enzyme is "vit B12 dependant homocisteine methyltransferase"). Been a strict vegan is a rare cause of B12 deficiency since B12 deposits tend to remain for years.. Since this peson has been a strict vegan for 10 years or so she is at a particular risk of this type of nutritional deficit.
Vit B12 def is also associated with methylmalonic acid accumulation (mthylmalonyl CoA mutase transforms the latter into succinylcoA). MMAcid destroys myelin sheaths producing ANY type of neurlogical deficit...
Edited by mazinger on 07/30/06 - 10:52 AM
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original mazinger z
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| veens
Forum Junior
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ya its b12 which needs to be estimated,and explanation has already been given by mazinger
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| vnty
Forum Senior
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a. folic deficiency due to diet will be faster, not as long as 10-year in this patient.
Also think of B12 deficiency if combined with other autoimmune diseases, gastro or intestial excision or surgery, eating raw fish
Diety cause of a. folic: overheat food, food is dilated in water. Also in malabsortion syndrome. Increased a. folic requirement or lost also causes a. folic deficiency like pregnancy, premature children, dialysis patients
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| veens
Forum Junior
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pt can have both folic &b12 def,but very imp to detect &treat with b12 before replacing folate to avoid neurologic dysfunction
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| drdiv
Forum Junior
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pt is having only vit b12 deficiency
folate is obtained from green leafy veg so he might not b having folate def.
correct me please
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| frank100
Forum Guru
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yup
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| yasmeen
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| shumaila
Forum Elite
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it is E
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