Transcription
Medicos is perfection. Alice, with a new topic: a comparison between folate and B12 deficiency anemia. We have talked previously about each one separately, but now let's do a nice comparison. Okay, quick question: which one had neurological symptoms? Huh, yes, B12 deficiency. Again, these are the symptoms of any anemia. We have said again and again and again: the MCV determines if the anemia is microcytic, normocytic, or macrocytic. Macrocytic anemia has more than 100 femtometers of MCV. Both B12 and folate deficiency are macrocytic. Also, microcytic anemia has two subtypes: megaloblastic and non-megaloblastic. Both B12 and folate are megaloblastic. And, of course, megaloblastic anemia will also have hyper-segmented neutrophils and may have pancytopenia and may have indirect hyperbilirubinemia. Because these macro-ovalocytes get destroyed by the macrophages and will produce bilirubin. So, which one of them will have anemia? Of course, both of them. But please be aware of the fact that folate deficiency can only have neurological symptoms without any symptoms of anemia.
How about the hemoglobin and hematocrit? Both are decreased in both of them. Why? Cuz it's anemia. Which type of anemia? Macrocytic. Which type of macrocytic? Megaloblastic. So that's both of them. How about the MCV? High. Why? Cause it's macrocytic. Reticulocyte count: do you think it will be increased? No, not increased; it will be decreased because the bone marrow cannot synthesize new red blood cells because it needs folate and B12 for DNA synthesis to form the RBCs. DNA replication is a process that eventually, down the road, will lead to the production of RBCs. So, reticulocyte count will not be increased; it will be normal or decreased. The reticulocyte production index will be less than 2.5. If you watch my video on reticulocytes, you will know what I'm talking about. What is the reticulocyte? How to correct it? He will know all of that.
Pancytopenia? Yes, it may be present in both of them. Why? Because they are megaloblastic, not just like microcytic specifically; they are megaloblastic. So pancytopenia could be there in both. Neurological? Only in B12 deficiency. Folate deficiency never has any neurological problems, unless maybe if caused by drugs, but it will be side effects of drugs, not necessarily the folate. Homocysteine? Both elevated in both of them. Methylmalonic acid? Only with the B12. So if homocysteine and methylmalonic acid are increased, this is B12. How to remember that? B12: both are elevated. That's cool. What else? How about achlorhydria? Yes, it can be present only in B12 deficiency. Every case? No, no. Some of the cases. The cases with pernicious anemia, okay, or gastritis will get achlorhydria. Not all cases, only gastric cases; stomach-related causes.
How about anti-intrinsic factor antibodies? B12 can have it only with pernicious anemia; folate, none. Atrophic gastritis, usually chronic, will be with vitamin B12 deficiency. Again, specific cases with pernicious anemia and with atrophic gastritis. How about gastric adenocarcinoma? Yes, pernicious anemia increases the risk for gastric adenocarcinoma. Pernicious is evil; the word tells you the answer on pernicious: yes, there is increased risk of gastric adenocarcinoma. How about the serum gastrin? Serum gastrin will be elevated in cases of pernicious anemia, chronic gastritis. Why? This stomach is not doing its job, so gastrin will increase. Why? Why the stomach is not doing its job? Let me produce more gastrin, more gastrin to try to influence the stomach and stimulate the stomach to produce more acid, more pepsin, and so forth.
How to treat folate deficiency and B12 deficiency? Easy. First, you have to correct the underlying disease in both of them. If it's a medicine, stop the medicine. It's another disease; try to treat it. And then, in folate, we get folate, usually oral, and with B12, we give B12, usually intramuscular. I hope it's clear; it's so easy now. Question of the day: what is the reticulocyte production index? Please let me know in the comments. We'd like to know more. My previous video on reticulocytes can help you. And if you'd like to get the previous questions, go to my Facebook page: www.facebook.com/medicosis. And please study hard, and let me see you in the next section.