Dietary deficiency
(nfant
malnutrition
KKA-481 Mira Yulianti (01-107)
-lco$olic cirr$osis
Pregnancy
Folate
antagonists
Patophisiology
B12 and folate deficiencies result in defecti!e
D4- synt$esis
,$is results in an abnormal cell maturation
"rocess
Most likely megaloblastic cells die in t$e bone
marro#
Major Clinical Characteristic
B12 deficiency ' Neurologic symptoms+ glossitis
8beefy red tongue9; gastrointestinal sym"toms
Folate deficiency ' &imilar to features abo!e+ but
#it$out neurological "roblems
aboratory !esting
<emogram
Mor"$ology
Bone marro# e0amination 8rare9
&erum B12
&erum folate
:t$er tests
"emogram Pattern in Megaloblastic Anemia
=BC 4/
<gb
MCV
PL, 4/
Peripheral #loo$ Morphology
-nisocytosis
Macro)o!alocytes
Possible megaloblasts
%iant and $y"ersegmented neutro"$ils 8P- "olys9
Possible granule deficient "latelets
#one Marro% Fin$ings
<y"ercellular
KKA-481 Mira Yulianti (01-107)
Macroovaloc
yte
RPl < 2
Polychromatop
hilic
Macrocyte
&P'()
Predominantly megaloblastic eryt$ro"oiesis
%iant granulocyte "recursors
4uclear)cyto"lasmic async$rony
Possible decreased megakaryocytes and nuclear
c$anges
*erum #+, an$ Folate Assays
Princi"le ' Com"etiti!e "rotein binding
radioimmunoassay
=as$ing to remo!e unbound radioacti!e labels
)scintillation counting
7esidual radioacti!ity is in!ersely "ro"ortional
to t$e amount of "atient>s B12 and folate
7esult determined by com"arison to standard cur!e
&"ecimen re.uirements
&erum "referred
/D,- "lasma acce"table
Fasting s"ecimen for folate
-!oid $emolysis for folate assay
&"ecimen storage
Protect from lig$t 8folate9
2)?@C for 1 $ours
)2A@C longer "eriods
&"ecimen "re"aration' boiled or e0"osed to an alkaline agent
7eference ranges
&erum B12 ' 1AA)6AA "g/mL
&erum Folate ' 1)15 ng/mL
Lo#er limit for B12 deficiency not #ell defined
(n untreated "atients #it$ folate deficiency
le!els are usually B1.A ng/mL
:t$er tests may be needed in borderline cases
&c$illing test
Crine formiminoglutamic acid 8F(%lu9' Increased in
B12 and folate deficiency
Crine/serum met$ylmalonic acid 8MM-9
&"ecific for B12 deficiency
/le!ated in B12 deficiency
Serum B
12
and Folate Assays
B
12
57
Co
IF
F
L
125
I
IF
L
F
125
I
F
125
I
B
12
B
12
57
Co
57
Co
B
12
Pts Vitamin B
12
F
Pts Folate
57
Co
57
Co-labeled cobalamin
125
I
125
I-labeled folic acid
IF Intrinsic factor
L
-lactoglobulin
KKA-481 Mira Yulianti (01-107)
!reatment
(ntramuscular inDections of !itamin B12 e!ery 1)1 mont$s
/ffects '
(ncreased reticulosits count in 3)6 days
<C, in reference range in 1)2 mont$s
:t$er 7BC "arameters return to normal
<y"ersegmented neutro"$ils disa""ear in 2 #eeks
Platelet count normal #it$in 6 days
KKA-481 Mira Yulianti (01-107)