S/O

Assessment

Plan

Problem: S/O evidence

Etiology

Recommended Therapy

Goals/Monitoring Parameters

Patient Education

  Subjective:

-Weakness

-Sore Tongue

-Peripheral neuropathy

-Neurologic symptoms (tinnitus, neuritis, vertigo, and HA)   

Objective:

-Serum vit. B12 ß

-MCV (macrocytic) Ý

-MCHC (homochromic/ normochrmic) ß Û

-Reticulocytes ß

-RDW (variation) Ý

-Hgb and Hct ß

Schilling’s Test-evaluates Vit B12 absorption.  < 5% (+) for P. anemia. [Normal 15-50%)

*1).Inability to absorb Vit B12 (at the distal ileum)

-Reduced intrinisic factor

-Reduced acid secretion/H2-receptor blockers

-Occurs freq. In pts with:

--Thyrotoxicosis

--Hashimoto’s thyroiditis

--Vitiligo

--Rheumatoid Arthritis

--Gastric cancer  

2).B12 Deficiency:

-Inadequate intake of B12

-Decreased absorption, transport,utilization

--inherited atrophic gastropathy

--Reduced intrinisic factor

--gastrectomy (ilialsectomy)

--Pancreatic insufficiency

--Bacterial overgrowth in the intestine

--Transcobalamin deficiency

Vit. B12- important for hematopoiesis, maintanence of myelin throughout CNS, production of epithelial cells.    

Minimum Daily Requirement: 1-5 mcg/day vit. B-12 

Daily lost:  1mcg/d  

Deficiency Symptoms develop: 3-4 yearsàBody storage: 2000-5000 mcg and enterohepatic recirculation    

Adults:

IM:  Vitamin B12 (Cyanocobalamin)

100mcg IM QD x 2 weeks then 100mcg IM Qmonth indefinitely

PO:  Available for Pt w/ contraindication to Parenteral but requires HIGH doses (500-1000mcg) not recommended due to lack of compliance and efficacy.    

IF D/C, reoccurance in 5 yrs

Goals:  

Correct underlying cause

Restore B12 levels

Relieve Symptoms

Restore Hgb, Hct

Monitor:

PO/IV Therapy Response—

-Neurologic: Symptoms-improve within 24 hrs

-Reticulocytes – normal by 5 days

-Hct—normalized in 1-2months

-Bone marrow-normoblastic w/in 48h

-Hematologic parameters improvement in few days  

**Monitor CBC q3-6months to evaluate efficacy

Regular Healthy Diet (meat and dairy)