Case Study Vit B12

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Tosha Kight

Case Study 90
Vitamin B12 Deficiency Anemia

Patient Case Question #1:


Identify three major risk factors that have likely contributed to a vitamin B12 deficiency state in the
patient.
#1: Excessive use of alcohol and cocaine since age 17
#2: Long history of poor nutrition
#3: Use of OTC famotidine “almost every day” for the past 2 years for heartburn.

Patient Case Question #2:


Clinical symptoms are subjective expressions of disease that can only be reported by the patient.
Identify a minimum of eight symptoms in the case study above that are consistent with a diagnosis of
vitamin B12 deficiency.
#1: (+) paresthesias, upper and lower extremities bilaterally
#2: Pallor with mild jaundice
#3: Beefy- red tongue consistent with glossitis
#4: Mini- mental exam 25/30 (recent memory was mildly impaired)
#5: Mild 4/5 weakness of iliopoas muscle on right side
#6: Response time was somewhat slow
#7: Unsteady with eyes closed
#8: Slow, cautions, unsteady, and wide based

Patient Case Question #3:


Clinical signs are objective expressions of disease that can be detected by someone other than the
patient. Identify a minimum of fifteen signs in the case study about that are consistent with a diagnosis
of vitamin B12 deficiency.
#1: Excessive use of alcohol and cocaine since age 17
#2: Long history of poor nutrition
#3: Use of OTC famotidine “almost every day” for the past 2 years.
#4: Pallor with mild jaundice
#5: Beefy- red tongue consistent with glossitis
#6: Systolic murmur heard best at right sternal border
#7: Positive bowel sounds
#8: response time was somewhat slowed
#9: Mini- mental exam 25/30 (recent memory was mildly impaired)
#10: XII tongue protruded mid- line
#11: Mild 4/5 weakness of iliopsoas muscle on right side
#12: Diminished pinprick and temperature sensations in stocking and glove distribution
#13: Sense of vibration lost in both lower extremities from knees down
#14: Unsteady with eyes closed
#15: Slow, cautious, unsteady, and wide based
Patient Case Question #4:
Identify a minimum of twelve laboratory blood test findings that are consistent with a diagnosis of
vitamin B12 deficiency.
#1: Vitamin B12
#2: Folic acid
#3: MMA
#4: Homocysteine
#5: RBC
#6: WBC
#7: Retic
#8: Hematocrit
#9: Hemglobin
#10: Indirect Bilirubn
#11: MCV
#12: Platelet count

Patient Case Question #5:


Identify ALL abnormal laboratory blood test findings in table 90.2 that are not necessarily specific for a
vitamin B12 deficiency.
#1: Cl
#2: Hb
#3: Hct
#4: RBC
#5: Plt
#6: WBC
#7: Retic
#8: MCV
#9: MCH
#10: Vit B12
#11: T Bilirubin
#12: Bilirubin, indirect
#13: Alb
#14: T protien
#15: MMA
#16: Homocysteine

Patient Case Question #6:


Is the patient renal function normal or abnormal?
-Alb (albumin) is abnormal = 3.0 g/dL normal level is 3.5-5.5 g/dL

Patient Case Question #7:


Is the patients hepatic function normal or abnormal?
-AST and ALT are normal

Patient Case Question #8:


Is the patients lipid profile normal or abnormal?
-TChol, HDL, LDL, and Trig are all normal
Patient Case Question #9:
Does this patient have pernicious anemia? Briefly explain your answer.
-Yes! On the peripheral blood smear the patient had macrocyclic red blood cells which is
pernicious anemia that is caused by vitamin B12 deficiency.

Patient Case Question #10:


The patient in this case study has…
A. Megaloblastic anemia
B. Neurologic abnormalities
C. Both A and B
D. None of the above
-C. Both A and B

Patient Case Question #11:


What is the medical terminology that s used for “neck pain shooting down the back and into the arms”
and what is the significance of this patients complaints?
-Cervical rediculopathy caused by inflammation

Patient Case Question #12:


What is causing this patients so- called slapping gait?
-The neurological deficiencies caused from the vitamin B12

Patient Case Question ##13:


What is the significance of the Romberg test in this patient?
-This is a test of the body’s sense of positioning that requires a healthy functioning of the dorsal
columns of the spinal cord. It helps to determine if this patient has any sort of neurological
abnormalities.

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