Advances in Nutrition United Statesp. European Journal of Clinical Investigation, p.
Immunology Letters, p. Aurelian Udristioiu¹, Radu G. History: a 70 year old engineer, following 8 years vegetable — dietary, was admitted to the county hospital, in neurology department, with diagnostic of poli-radiculonevrites, received in ward the treatment with milgama containing micro-gram multivitamin.
After a lipotimia status the patient was transferred to cardiology department. Macrocytes and ovalocytes where also presented.
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Biopsy results from gastric mucosa showed lesions of chronic gastritis, non-atrophic epithelium. Conclusions: Megaloblastosis appears in some time with vitamin B12 deficiently in bone morrow neuroendocrine cancer biopsy no in peripheral blood because of administration of multivitamin drugs, deleting haematological shape of megaloblastic anemia.
Keywords: Wait blood cells, Erythrocyte sedimentation ratio, haptocorin, transcobalamin. The Corresponding author of this manuscript is Aurelian Udristioiu¹Department of Hematology, Emergency County Hospital Târgu Jiu, Clinical Laboratory, Gorj, and contribution of the authors as mentioned below with their responsibility in the research. Radu G. Publisher: Aurelian Udristioiu.
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Reviewers' field: No. The aim of this work was to illustrate, by one difficult case patient, admitted in hospital, the diagnosis of B12 vitamin deficiency, intrigued with iron deficiency, because of multivitamin drugs, used as an individual treatment of patient, without a previous medical consult.
History: A 70 year old engineer, since 8 years vegetable — diet, was admitted to the county hospital in month august 20 —because of weakness, 10 kilo in last two months], dizziness, exertional dyspneea, ataxia and numbress of the hands, with lung disease in evolution. Psychiatric symptoms such as memory disturbance, depression and cognitive decline have been also reported. After outcome from hospital, at home, the patient presented lipotimia status, confusion and was admitted in cardiology department.
Hematologic analyser showed neutrophilia, lymphopenia and the microscopy exam on peripheral blood smears showed the dimorphic picture and pancytopenia. At examination of bone morrow occurred increased erythropoiesis which was megaloblastic in character, giant band forms, large metamilocytes. Biopsy results from gastric mucosa showed lesions of chronic gastritis, non-atrophic. Another para-clinical examinations [abdominal echografic, barium-rx exam], have been normally. Diagnosis: anemia by cobalamin deficiency and iron deficiency The patient followed therapeutic sample [with B12 vitamin, gamma, im.
The blood smear shows anisocytosis: normocytosis with ease macrocytosis. Efficiency of treatment in neuroendocrine cancer biopsy will be monitored and by performing of metilmalonic acid test heparnied plasma and homocystein level EDTA plasma.
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Comment: In first time the neurogical manifestation occurred to neuroendocrine cancer biopsy in absence of blood picture in peripheral blood of typical megaloblastic anemia. To the patient with vegetable diet anemia by B12 neuroendocrine cancer biopsy is accompanied of neurological syndrome with frequently iron deficiency, specialty to elder men. This case illustrates many interesting points that are considered atypical of deficiency in B12 vitamin.
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In first time, the neurological manifestations occurred to this patient in the absence of anemia. When a patient with anemia by B12 vitamin deficiency has the neurological features of disease without the characteristic hematologic abnormalities, the diagnosis is difficult. On such circumstance, the patient has received B12 vitamin and folic acid in an amount that is sufficient to convert the megaloblastic anemia type of erythropoiesis to the normoblastic type in peripheral blood and raise the erythrocyte count.
The anemia was normocytic and not associated with leucopenia, thrombocytemia in peripheral blood.
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The diagnosis of deficiency B12 vitamin was established by the response to specific therapy. When and iron deficiency is severe the anemia is hypochromic and microcytic but in milder degrees of iron deficiency the anemia is normocytic. A combined deficiency of iron B12 vitamin might result in a normocytic anemia that required both iron and vitamin B12 in treatment .
Impaired absorption flatulenta la nou nascuti vitamin B12 occurs and neuroendocrine cancer biopsy other conditions different of diet deficiencies associated with diarrhea or other evidence of the mal-absorption syndrome.
Such impairment has been demonstrated to patients with: - Blind intestinal loops, fistulae, strictures, and diverticula of the small bowel, - Gastrectomy, because absence of the gastric intrinsic factor, altered gastric secretion, gastric atrophy with degenerative lesions, mal-absorption syndrome, neuroendocrine cancer biopsy duodenal disease and pancreatic, abnormal bacterial proliferations in bowel, infestation with parasites, failure pancreatic, liver, chronic hepatitis cirrhosis, - Disease of lymphoma group, myeloproliferative syndrome MSD by elevated consummations in neoplasia and hyperthyroid — but a study of the bone morrow usually enable one to establish the diagnosis neuroendocrine cancer biopsy.
In some patient particularly since the advent of folic acid and the widespread use of multivitamin preparations the aematological abnormalities are mild or absent when neuroendocrine cancer biopsy manifestations are predominant.
The bone morrow is usually hyper-cellular. The characteristic feature is the occurrence of the megaloblastic type of erythropoiesis. If anemia is severe, promegaloblastic and basophilic megaloblasts are increased in number and mitotic divisions are numerous .
The polychromatophilic megaloblasts which are neuroendocrine cancer biopsy cells to identify in this serious persist even after the anemia in the peripheral blood has been abolished by transfusion. Deficiency of vitamin B12 or folic acid also leads to the production of giant metamielocytes and multi-segmented macropolicites. The abnormalities in the granulocytic series do not disappear as promptly as then megaloblasts after specific therapy and their present may be helpful in diagnosis.
There are the conversion of neuroendocrine cancer biopsy megaloblastic type of erythropoiesis to the normoblastic type within two day, a rise in reticolocytes during the first week, and a return of the haemoglobin and red count to normal levels in succeeding weeks. The recent years the picture has become more complex. In last time, attention has neuroendocrine cancer biopsy been focused on measuring metabolic levels methylmalonic acid [- Neuroendocrine cancer biopsy -], and homocystein [- Hcy -], as these should accumulate when a deficiency stare exists.
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However, both of these methabolits can be affected by the renal function of the patient and Hcy can be elevated when there is an underling folate deficiency . The situation becomes more warring when abnormal levels of metabolites are detected but the total Hcy are apparently well within normal range.
The notion that metabolic levels change before that total Cbl levels decreases this fact not proven. Current made techniques for measuring plasma Cbl that is bond to both haptocorin [HC] and transcobalamin [TC], complex describing Holo-Transcobalamin.
Hololotranscobalamin has been neuroendocrine cancer biopsy as a better marker for cobalamin deficiency because of: - measures the physiologically relevant fraction of circulating cobalamin, -It has a neuroendocrine cancer biopsy and so may be a good early good marker. It is hoped that the new methods neuroendocrine cancer biopsy and physico-chemical methods] will be enable to the investigators to address the neuroendocrine cancer biopsy questions surrounding holo-trancobalamin and also enable carefully designed clinical surveys to be undertaken .
Conclusions: To the vegetarian elder men, anemia by deficiency of B12 vitamin is accompanied of neurological syndrome.
There are frequent and deficiency of iron also to neuroendocrine cancer biopsy patient which eats vegetal reached in folic acid, cofactor of B12 vitamin, but poor in B12 vitamin. Megaloblastoza appears in same time with B12 vitamin deficiency, in bone morrow but not in peripheral blood. Neuropathy was results from accumulations of a neuroendocrine cancer biopsy metylmalonic acid [from propionic acid] with decrease of acetyl-coA, ATP and energy cells.
Drugs with poli-vitamins administrated without corresponding investigations can delete haematological shape of megaloblastic anemia.
References  William S. EditorialClinical Chemistry ; 48 ; 3: Clinical Chemistry ; 8 ; 3: Clinical Chemistry ; 57 ; Practical Diagnosis of Hematological Disorders. Anemia of Chronic Diseases. Anemia in the elderly: how should we define it, when does it matter, and what can be done?. Mayo Clin Proc ; 82 8 : International Journal of Nutrition.