Question

L.K. s a 26 year old male who has been feeling tired for nearly six months. Lately he has been having problems talking and some difficulties with concentration and remembering things he had done the previous day. He has also had numbness in both his legs and weakness to the point of having trouble walking. L.K's symptoms started gradually and he also had progressive numbness and intermittent tingling in both of his hands.

In his past medical history he has had poor nutrition and became a vegetarian to help improve his overall wellness approximately 9 months ago. Previous to the nine months he had excessive alcohol and drug use. He reports being clean and sober for 9 months. He has lost 18 lbs. since he began his new diet.

On physical exam he exhibits glottitis. Stool guaiac test was negative. He had diminished pinprick and temperature sensations in stocking and glove distribution of hands and feet.

Lab tests were as follows:

Hb 10.9 g/dL

HCT 28.4%

RBC 3.44

Platelet 110  

Reticulocytes 21

MCV 123.4 fL

MCH 37.6 pg

MCHC 33.5 g/dL

Vit. B12 87 pg/mL

Folic acid 8 mg/mL

1. Given the lab results and signs and symptoms, what is your diagnosis?

2. The patients later reported he had shooting pains down his back and arms. What is the significance of this patient complaint?

3. How does his history relate to the onset of the symptoms and how does it relate to your diagnosis?

4. Describe the compensation mechanism of the blood cell production due to the imbalance of his disease?

Answer 1

1.The low hemoglobin levels,decreased Vitamin B12 and decreased folic acid with signs and symptoms of glossitis , pinpricks , lack of concentration, inability to talk,poor remembering capacity,temperature sensation,weakness ,numbness in both legs are typically associated inte with Pernicious anemia.In thus type weakness in present more in legs than the hands

2.Vitamin B12 deficiency usually leads to affecting the nerves and causing shooting pains as a symptom

3.A strict vegetarian diet for a prolonged time will lead to deficiency of Vitamin B12 .This vitamin is easily received in case of non vegetarian diet. The patient lack of adequate nutrients intake has led to this problem. Along with this the signs and symptoms are associated with this deficiency.

4.The compensatory mechanism for this deficiency are increased erythropoietin leading increased red blood cell production. Along with this the intrinsic factor in the gastrointestinal tract are stimulated to absorb vitamin B12 .Thus this increases the folic acid absorption which can lead to increase in hemoglobin levels and preventing the deficiency