Question

A John, 23-year-old male who is a vegetarian with severe fatigue, SOB, and recurrent chest palpitations presented to his primary care physician (PCP) when he noticed a paleness and yellow like tinge to his skin and tenderness in his epigastric region with when he would get dressed in the morning for work over the last few weeks. He says his parents said that they have noticed the yellow tinge in his eyes over the last two years. His PCP ordered some blood laboratory tests. When the lab work returned, it showed that John had severe vitamin B12 deficiency and pancytopenia. John was placed on cobalamin replacement therapy, and reported an increased well-being, with his appetite and weight gain and the yellow tinge resolved. After approximately three months, John had a follow-up, at that time John mentioned how well he was doing and staying committed to his vegetarian diet. He says he had not consumed any animal based food in about 2 ½ years. John said his diet mainly consisted of fresh fruit and vegetables that he grew in his own garden at home. During his follow-up exam, John looked pale and had weakness. His sclera were noted for a yellow tinge color. His heart rate was 94 bpm, 2/6 systolic murmur was heard on auscultation. The PCP ordered a peripheral blood smear that showed anisocytosis and poikilocytosis with macrocytes and schistocytes that mimick a microangiopathic hemolytic anemia, including hypersegmented neutrophils. No blasts were present. An abdominal ultrasound revealed splenomegaly. A cardiac echogram was normal. A bone marrow aspiration demonstrated macromegaloblastic erythropoiesis, and luckily leukemia was ruled out. John had also been noticing that he had begun difficulty walking and had numbness and tingling of his lower limbs at night while he was laying in the bed.

1. What is the diagnosis that John has developed?

2. What is the cause of John’s condition?

3. What diagnostic studies are needed to determine condition John has?

4. What is the treatment protocol for someone with John’s condition?

Answer 1

what is the diagnosis john has developed ?

With the above clinical information, a diagnosis of vitamin B12 deficiency was made. it was investigated further to find its cause. The dietary intake of B12 was fairly normal for his age. Anti-parietal cell antibodies and anti-intrinsic factor antibodies were negative. An upper gastrointestinal endoscopy showed erythematous gastropathy and gastric biopsy revealed Helicobacter pylori-induced chronic gastritis.

cause of john comdition?

Megaloblastic anaemia due to vitamin B12 deficiency is rare in childhood. Inadequate dietary intake of vitamin B12, impairment of gastric secretion, lack of intrinsic factor secretion by the stomach, impaired intestinal absorption of intrinsic factor (IF)-cobalamin complex, and the absence of vitamin B12 transport proteins (transcobalamin II) are the common causes of vitamin B12 deficiency.

diagnostic studies?

Treating vitamin B12 deficiency anaemia. Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, in a form called hydroxocobalamin. At first, you'll have these injections every other day for two weeks, or until your symptoms have stopped improving.

treatment protocol?

Oral administration of high-dose vitamin B₁₂ (1 to 2 mg daily) is as effective as intramuscular administration for correcting anemia and neurologic symptoms.