Question

(5) Data for 3 patients is presented below: (7 pts) Patient Serum RBC Homocys HgB MCV HoloTC Serum Serum RDW (nmol/L) nmoVL) omoVL) 284 368 18.3 8.2 108.6 29 13.4 123 Bert ( 168 35384 94 l103.2 44 29886 192 12.1 8.4 7.6 13.2 398 322 124 8.6 84.5 42 Possible diagnoses: Early depletion/depletion stage (B12) Early Deficiency stage (B12) Anemia from B12 deficiency Early depletion/depletion stage (Folate Early Deficiency stage (Folate) Anemia from Folate deficiency Recovering from Folate Deficiency Anemia Recovering from B12 Deficiency Anemia Moderately Anemic (but NOT from either a Folate or Bi2 deficiency) Based on all the above data, write the "most consistent" diagnosis (choose from diagnoses listed above) with respect to their lab values next to the patient name. Also, indicate whether each patient should have the following tests done. Test for Intrinsic- Factor Antibodies IF-Abs) Yes or No Diagnosis (from choices above) Patient Bert (F) Jill (Preg) One of the 3 patients is vitamin B12 deficient. Who is it?

Answer 1

NAN - Early deficiency stage B12.

Nan has low serum vitamin B12 level, low Hb, and Low holo Tc level. Low HoloTc level is an indicator of vitamin B12 deficiency. So NAN has the possible diagnosis of Early deficiency stage.

Test for intrinsic Antibodies is required because most of the vitamins are absorbed in the small intestine through the intrinsic factors.

Bert - Recovering from B12 Deficiency Anemia.

Bert has a low Hb level, elevated MCV value, Low homocyst level, and low serum MMA value. RDW also elevated. But her serum B12 is normal. This shows that she is recovering from Vitamin B12 deficiency anemia.

Test for intrinsic factor antibodies is required to know the absorption of vitamin B12.

Jill - Moderately anemic.

Jill has a low Hb level. Otherwise, her blood levels are normal. She has normal vitamin B12 and folate levels. She is moderately anemic which is common during pregnancy.

Test for intrinsic factor Abs is not required.

Nan is vitamin B12 deficient. He has a low serum vitamin B12 level.