Question

(7 pts) (5) Data for 3 patients is presented below: Serum RD Patient Serum RBC Homocys HgB MCV HoloTC Serum S | (%) | MMA | B12 | (pmol/L) | (g/dL) | (fl.) | (nnol/L) | folate folate (nmo/L) (nmol/L omolL) (pmol/L) 123 134 284 Nan 12.5368 18.3 82 108.6 29 Bert ( 16.8 353 84 Jill 19.2 12.1 103.244 84.5 86 124 298 322 9.4 8.6 42 7.6 398 13.2 Possible diagnoses: 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 B12 deficiency) Early depletion/depletion stage (B12) Early Deficiency stage (B12) Anemia from B12 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 Nan (M) Bert () Jill (Preg) One of the 3 patients is vitamin Bi2 deficient. Who is it?

Answer 1

Normal levels:

Serum folate: 4.5-45.3 nmol/L

RBC folate:  317-1422 nmol/L

Homocys: 4-10 µmol/L

HgB: Male:  13.5- 17.5 g/dL Female: 12-15.5 g/dL

MCV: 80-96 fL

HoloTC: 42.48 pmol/L

Serum B12: 115 - 1000 pmol/L

Serum MMA: 0.10 -0.40 micromoles/L

RDW %: 11.5-14.5%

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NAN (male): His serum folate and RBC folate are at low end of normal range

His homocysteine level is high . It may be associated with low levels of vitamins B6, B12, and folate, as well as renal disease. Homocysteine is high when someone has VITAMIN B12 deficiency . So the man has VIT b12 deficiency.

His hemoglobin levels are also low.His MCV is high

His serum B12 range is also at low end of normal range.

His HoloTC ( holotranscobalamin) is low .It is a sensitive marker of early vitamin B-12 deficiency.

Diagnosis: Anemia from B12 deficiency .

He may have decreased Vit B12 due to lack of intrinsic factors .

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BERT( female); Her serum folate and RBC folate are within reference range.

Her homocycteine level is at higher end of normal range.

Her hemoglobin is low.Her MCV is high .

Her holotranscobalamin level is normal .Her serum B 12 level is within range.

Her serum methylmalonic acid is near low range .

Her RDW is 19.2% and MCV is high may be due to folate or Vit B12 deficiency . But the levels are at near normal .

Diagnosis:Recovering from B12 deficiency anemia

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JILL (pregnant): Her folate is near low normal range.

Her RBC folate is within range.

Her homocysteine is also within range.

Her hemoglobin is low representing anemia. Pregnancy is a period leading to more dilution of blood which in turn leads to anemia . Also pregnancy needs more RBC 'S for the fetus.

Her serum B12 is normal and hemoglobin is low and her RBC folate is normal which represents she is recovering from Folate deficency anemia.

Diagnosis: Recovering from folate deficiency anemia.