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[Vitamin B12 deficiency. New data on an old theme]
Klaus Lechner1, Manuela Födinger, Wolfgang Grisold
1Abteilung Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Osterreich. klaus.lechner@meduniwien.ac.at
Wiener Klinische Wochenschrift
|January 7, 2006
Summary
Cobalamin deficiency is common, especially in older adults. Early diagnosis and treatment are crucial, as symptoms like anemia and neurological issues may not always be obvious.
Area of Science:
- Endocrinology
- Gastroenterology
- Hematology
Context:
- Cobalamin (vitamin B12) deficiency affects 10-20% of the elderly, often without clear symptoms.
- Typical signs include macrocytic anemia, neuropsychiatric issues, and glossitis, but this triad is frequently absent.
- Serum cobalamin levels require careful interpretation; normal results do not rule out deficiency.
Purpose:
- To review the diagnosis, causes, and management of cobalamin deficiency.
- To highlight the diagnostic challenges and utility of cobalamin activity markers.
- To discuss treatment strategies and long-term risks associated with pernicious anemia.
Summary:
- Atrophic gastritis, caused by autoimmune processes (pernicious anemia) or H. pylori, is the primary cause of cobalamin deficiency.
- Food cobalamin malabsorption differs from pernicious anemia in intrinsic factor levels and treatment response.
- While hematological recovery is common, neurological and psychiatric symptoms may show limited response to treatment.
Impact:
- Accurate diagnosis and management of cobalamin deficiency can prevent serious hematological and neurological complications.
- Understanding the different causes of deficiency guides appropriate treatment, including oral or parenteral cobalamin.
- Patients with pernicious anemia face an elevated risk of gastric carcinoids, necessitating long-term monitoring.