{"id":1436,"date":"2017-07-18T06:05:31","date_gmt":"2017-07-18T06:05:31","guid":{"rendered":"http:\/\/papergp.com\/index.php\/data-interpretation\/b12-and-folate\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"b12-and-folate","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/data-interpretation\/b12-and-folate\/","title":{"rendered":"B12 and Folate"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>B12 deficiency<\/strong><\/h4>\n<ul>\n<li>Causes\n<ul>\n<li>Pernicious Anaemia<\/li>\n<li>Gastric &#8211; atrophic gastritis, gastrectomy<\/li>\n<li>Intestinal &#8211; resection, malabsorption<\/li>\n<li>Dietary<\/li>\n<li>Medications &#8211; colchicine, PPIs\/H2 receptor antagonists<\/li>\n<\/ul>\n<\/li>\n<li>Apparent deficiency\n<ul>\n<li>Metformin<\/li>\n<li>Pregnancy<\/li>\n<li>Oral contraceptives<\/li>\n<li>HRT<\/li>\n<\/ul>\n<\/li>\n<li>Investigations\n<ul>\n<li>Consider intrinsic factor and parietal cell antibodies<\/li>\n<li>Consider anti-TTG<\/li>\n<\/ul>\n<\/li>\n<li>Treatment\n<ul>\n<li>Patients with neurological symptoms\n<ul>\n<li>Do not delay treatment<\/li>\n<li>Loading: 1000mcg hydroxycobalamin IM every second day until no further improvement<\/li>\n<li>Maintenance: 1000mcg hydroxycobalamin IM every 2 months for life<\/li>\n<\/ul>\n<\/li>\n<li>Patients with no neurological symptoms\n<ul>\n<li>Loading: 1000mcg hydroxycobalamin IM Mon\/Weds\/Fri for two weeks<\/li>\n<li>Maintenance:<\/li>\n<li>Non dietary: 1000mcg hydroxycobalamin IM every three months for life<\/li>\n<li>Dietary: 1000mcg hydroxycobalamin IM twice per year or 100mcg cyanocobalamin PO (if dietary deficiency is corrected, treatment can be stopped when levels normalised but ensure dietary advice given)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Refer B12 deficiency if\n<ul>\n<li>Haematology: Pregnancy, neurological symptoms, uncertain aetiology, persistent symptoms despite replacement<\/li>\n<li>Gastroenterology: suspected malabsorption, pernicious anaemia with GI symptoms<\/li>\n<li>Dietician: concerns regarding diet<\/li>\n<\/ul>\n<\/li>\n<li>Monitoring response to B12 replacement\n<ul>\n<li>FBC and reticulocytes 10 days following initiation of treatment &#8211; check folate if no improvement<\/li>\n<li>FBC at 8 weeks to ensure normalisation of Hb<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>B12 raised<\/strong><\/h4>\n<ul>\n<li>Causes\n<ul>\n<li>Excess intake\n<ul>\n<li>Oral or IM B12<\/li>\n<\/ul>\n<\/li>\n<li>Excess production of transcobalamins\n<ul>\n<li>liver disease<\/li>\n<li>myeloproliferative disorders<\/li>\n<li>neoplasms &#8211; particular liver<\/li>\n<li>inflammation &#8211; SLE, RA<\/li>\n<\/ul>\n<\/li>\n<li>Defective clearance of transcobalamins\n<ul>\n<li>renal failure<\/li>\n<li>anti TCB antibodies<\/li>\n<\/ul>\n<\/li>\n<li>Hepatic release of transcobalamins\n<ul>\n<li>liver disease &#8211; alcohol, hepatitis, cirrhosis<\/li>\n<\/ul>\n<\/li>\n<li>Other\n<ul>\n<li>Congenital deficiency in transcobalamins<\/li>\n<li>Defect in TCB-B12 affinity<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Investigations<\/li>\n<li>Physical examination &#8211; lymphadenopathy<\/li>\n<li>FBC, U+Es, LFTs inc GGT, ESR, CRP<\/li>\n<li>CXR<\/li>\n<li>USS abdomen + pelvis<\/li>\n<li>NB: transcobalmins are involved with delivery of B12 to cells<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Folate deficiency<\/strong><\/h4>\n<ul>\n<li>Causes\n<ul>\n<li>Dietary &#8211; often secondary to alcohol<\/li>\n<li>Malabsorption &#8211; Coeliac disease, tropical sprue, IBD, jejunal resection<\/li>\n<li>Excess requirements &#8211; Physiological (pregnancy, infancy), Haemolysis (Sickle cell), Inflammation (TB, Crohn&#8217;s), Malignancy<\/li>\n<li>Medications &#8211; Methotrexate, sulfasalazine, anticonvulsants, cholestyramine<\/li>\n<li>Metabolic<\/li>\n<li>Excess urinary excretion &#8211; CCF, chronic dialysis, acute liver damage<\/li>\n<\/ul>\n<\/li>\n<li>Treatment\n<ul>\n<li>Ensure B12 levels normal\/replaced (to avoid subacute combined degeneration of the cord)<\/li>\n<li>Dietary advice<\/li>\n<li>Folic acid 5mg OD for four months (may require prolonged treatment if cause persists)<\/li>\n<\/ul>\n<\/li>\n<li>Monitoring response to folate replacement\n<ul>\n<li>FBC and reticulocytes 10 days after intiation of treatment<\/li>\n<li>FBC at 8 weeks to ensure normalisation of Hb<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>B12 deficiency Causes Pernicious Anaemia Gastric &#8211; atrophic gastritis, gastrectomy Intestinal &#8211; resection, malabsorption Dietary Medications &#8211; colchicine, PPIs\/H2 receptor antagonists Apparent deficiency Metformin Pregnancy Oral contraceptives HRT Investigations Consider intrinsic factor and parietal cell antibodies Consider anti-TTG Treatment Patients with neurological symptoms Do not delay treatment Loading: 1000mcg hydroxycobalamin IM every second day until &hellip; <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/b12-and-folate\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">B12 and Folate<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1261,"menu_order":29,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1436","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1436","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=1436"}],"version-history":[{"count":4,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1436\/revisions"}],"predecessor-version":[{"id":2209,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1436\/revisions\/2209"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1261"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=1436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}