Vitamin B12 deficiency anemia
Since childhood manifested the forms of vitamin B12-deficiency anemia, which are caused by inherited disorder education intrinsic factor (it is necessary for the absorption of vitamin B12 or vitamin B12 absorption and lack of blood plasma protein that transports the vitamin B12-transcobalamin.
inherited disorderseducation intrinsic factor is transmitted in an autosomal recessive inheritance and described in 24 boys and 23 girls. during the first year the children's blood counts are within the normal range. in the second year of life appear severe weakness, diarrhea, irritability. The child loses weight, appetite disappearsappear waxy pallor, often yellowing of the sclera and skin. Sometimes atrophy mucosa tongue with redness papillae. often, increased liver and spleen. gastric secretion may be normal. In the study of pieces of gastric mucosa tissue taken during EGD, signs of atrophy is not detected.Sometimes dramatically reduced unconditioned reflexes.The serum point decrease in vitamin B12.Suction lab
In the literature there is a description the case of vitamin B12 deficiency in a boy 13 years, the contents of which intrinsic factor was normal.However, the internal factor is not provided the absorption of vitamin B12.The addition of normal gastric intrinsic factor and concentrate normalized absorption of the vitamin.The reason B12 deficiency anemia in this case was that the body formed boy functionally inactive intrinsic factor.
Regardless of the reasons for vitamin B12 deficiency, there is a loss of the hematopoietic tissue, digestive and nervous systems.Gradually, the child begins to fatigue, weakness, palpitations, shortness of breath on exertion.Many children are in for a number of years to complain of abdominal pain.
Children with B12-deficiency anemia are often full, with a puffy, and in severe anemia, jaundice, pale face.Sometimes deficiency of vitamin B12 is determined by a slight rise in body temperature.Some individuals may appear in the language of pain that is associated with the appearance on its sites of inflammation.However, signs of inflammation of the tongue, both objective and subjective arise only 1/4 of people with vitamin B12 deficiency.Generally tongue inflammation is not a characteristic sign of vitamin B12 deficiency, as glossitis (tongue inflammation) and is iron-deficiency anemia.In some cases there is an increase in the spleen, and occasionally the liver.Education of gastric juice in the majority of patients with vitamin B12 deficiency dramatically reduced.When X-ray of the stomach often detect violations of evacuation of food, as well as the pathological changes of gastric mucosa folds.One of the characteristic symptoms of vitamin B12 deficiency is nerve damage, which is usually called funicular myelosis.The earliest manifestations of the nervous system are the appearance of feeling of "pins and needles" (paresthesia) and sensory disturbances with constant light by pain, tingling, pins reminiscent, feeling cold, "padded feet", numbness in the limbs.Less common are girdle pain.
Quite often expressed muscle weakness, muscle atrophy can be.By the phenomena of polyneuritis (multiple lesions of nerves right) joins the spinal cord lesion.The lower limbs are affected first of all, in most cases, symmetrically.With the progression of the process is broken surface sensitivity, the ability to distinguish hot from cold, reduced pain sensitivity.Defeat can be spread on his stomach and even higher.Hands are affected less and less, than the feet.In severe cases, impaired vibration and deep sensitivity.Some children have lost the sense of smell, hearing, taste is broken.In rare cases, can appear mental disturbances, delusions, auditory and visual hallucinations, and sometimes seizures.In the most severe cases, there is exhaustion, lack of reflexes, persistent paralysis of the lower limbs.
main method of treatment of this type of anemia - intramuscular injection of vitamin B12 or assign it to the inside in very large doses, sometimes together with intrinsic factor.However, it quickly produces antibodies to the foreign protein, and absorption is disturbed.For intramuscular use drugs such as cyanocobalamin and hydroxocobalamin.The aqueous solution of cyanocobalamin very quickly gets into the blood, its maximum serum concentration observed in 1.5-2 hours after administration.Almost all of the administered amount excreted in the urine, from 1 mg cyanocobalamin in the body is only 50-80 mg.Hydroxocobalamin absorbed from the injection site as quickly as cyanocobalamin, its concentration in serum reaches a maximum at 2 h after administration.However, unlike cyanocobalamin, hydroxocobalamin much better bound to blood proteins.After administration of 1 mg of drug in the body is 25-33%.
available sustained release formulations - vitamin complexes in the form of an oily suspension.A drug;It enters the blood slowly, 1 mg of the body is 90-98%, but after the introduction of these drugs are poorly absorbable infiltrate at the injection site.large doses of vitamin B12 (1000 mcg daily) is used in funicular myelosis.
In all cases, the deficiency of vitamin B12, vitamin use should lead to a rapid and long-lasting positive results.Inefficiency of vitamin B12, likely to say that you a wrong diagnosis was made.