Therapy
This patient's regimen of vitamin B12 injections was a sensible approach to management. B12 can be given orally if the patient prefers. Injection became universal practice because almost all cases of diagnosed B12 deficiency result from malabsorption. Nevertheless, even when the stomach does not produce intrinsic factor, vitamin B12 deficiency can often be corrected with very large oral doses-1,000 µg a day.
An estimated 1% of the oral dose crosses the gut mucosa by diffusion, which may be sufficient to reverse the deficiency. If injection is chosen as the route of administration, the costs and inconvenience of regular visits to the doctor's office can be obviated by teaching the patient or a relative to perform the injection.
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Comments
There is pancytopenia and the indices of RBC are macrocytic so in this setting the first Q is megaloplastic or non megaloplastic? and the answer is easy by see hypersegmented neutrophil in peripheral blood film or bone marrow second Q is if megaloplastic what is the cause folate or B12 deficiency and what is the cause of that? if non megaloplastic we have to rule out autoimmune hemolytic anemia, mylodysplastic syndromes, hypothyroidism.
She has gradual onset of anemic symptoms Her CBC shows macrocytic [MCV.95fl],increased RDW .Platelets counts m/b reduced(<100,000/mm3).No h/o recent bleeding exclude IDA.Jaundice exclude haemolytic .Medication with methotrexate, exclude folic acid B12 deficiency.Alcoholism exclude folic acid def.Hospitalization exclude b12 def in gastric operation.Normal BUN exclude anemia of chronic disease. Dx is probably megaloblastic anemia due to combined f/a and B12 deficiency with underlying hypovitaminosis,antimetabolytes, copper deficiency with zinc excess.Bone marrow will show megaloblasts and hypersegmented neutrophils.
Diagnosis is must before blood transfusion in this case
megaloblastic anemia
mostly pernious anaemia