Question

A 38 year old male complains of fatigue by the end of the day. He has experienced these symptoms for several months now. Recently he has noticed numbness and tingling in his feet. His labs reveal an RBC (2.9 L), HGB (11.0 L), HCT (32.4 L), MCV (111.2 H), and MCH (37.2 H).

Which follow up testing would you recommend to confirm deficiency? What type of anemia does this client have? How do you explain the neurological symptoms? What dietary and nutrient recommendations (including dosage) would you recommend? How soon do you expect to see a response? How long will you recommend this support for and why?

Answer 1

The 38-year-old male test reports show an inadequate count of RBC, and the hemoglobin, Hematocrit levels are lower than the normal value. But MCV and MCH are elevated. further, schilling Test is advised to confirm the diagnosis. In this test, a small amount of radioactive vitamin B₁₂ is administered orally to analyze the absorption of vitamin B_12. If no radioactivity present in the urine, it determines the malabsorption of vitamin B₁₂. The intrinsic Factor antibody test is also recommended to determine malabsorption.

The client is having Megaloblastic anemia. It is caused by the deficiency of vitamin B₁₂ or folate deficiency. These are essential for DNA synthesis. If there is a deficiency then the RBC's are produced abnormally called as megaloblasts. These cells die in the bone marrow before they mature which results in megaloblastic anemia.

The neurological symptoms of the client include

• confusion, numbness and tingling sensation in the lower extremities.
• Gait problem due to damage to spinal cord.
• Loss of vision due to atrophy of nerve impulses(optic nerve).
• Memory loss.
• Depression, listlessness, Insomnia, and panic attacks occur due to vitamin B₁₂ deficiency.

The dietary intake recommended for vitamin B₁₂ deficiency include

• chicken
• eggs
• Fortified soymilk
• fortified cereals
• Red meat

For Folate deficiency, the diet should consist of

• Oranges,
• Peanuts.
• Grains,
• Lentils
• Green leafy vegetables

In addition, 1mg of folic acid should be administered daily. Monthly, IM injection of vitamin B₁₂ 1000mcg is recommended for the absence of intrinsic factor or malabsorption.

The blood count returns to normal level within one to two week and symptoms will subside slowly which takes several weeks. The neurological symptoms take more time to recover.

To prevent the reoccurrence of megaloblastic anemia the dietary and treatment therapy should be continued throughout the life.