vitamin-b-12 and Jaundice

Topics: Acute Disease; Adolescent; Adrenal Glands; Adult; Clinical Trials as Topic; Cobamides; Coenzymes; Drug Combinations; Female; Hepatitis A; Hepatitis B; Humans; Jaundice; Liver Extracts; Liver Function Tests; Male; Nucleosides; Tissue Extracts; Vitamin B 12

The coexistence of adrenal failure with either autoimmune thyroid disease and/or type 1 diabetes is defined as autoimmune polyglandular syndrome (APS) type 2 or Schmidt's syndrome. Vitiligo, hypergonadotropic hypogonadism, chronic autoimmune hepatitis, alopecia, pernicious anaemia and seronegative arthritis may also be present. We present a case of 45-year-old Indian man with progressive jaundice and asthenia for 3 months. He was also found to have pallor, icterus, dry coarse skin and delayed relaxation of ankle jerk. Investigations showed pancytopaenia with megaloblastic changes due to pernicious anaemia, autoimmune hypothyroidism and autoimmune adrenalitis with evolving adrenal insufficiency. Upper gastrointestinal endoscopy guided biopsy showed evidence of gastric mucosal atrophy. Patient responded well to hydroxocobalamin and thyroxine replacement. Detailed workup to check for evolving APS II is prudent in a hypothyroid patient presenting with pallor and jaundice. It may alert physicians to possible adrenal crisis in the future, especially after starting levothyroxine replacement in these patients.

Topics: Addison Disease; Anemia, Pernicious; Hashimoto Disease; Humans; Jaundice; Male; Middle Aged; Polyendocrinopathies, Autoimmune; Syndrome; Thyroiditis, Autoimmune; Thyroxine; Vitamin B 12; Vitamin B Complex

Vitamin B

Topics: Adolescent; Anemia, Megaloblastic; Diet, Vegetarian; Directive Counseling; Female; Humans; Injections, Intramuscular; Jaundice; Patient Compliance; Patient Education as Topic; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Asthenia; Disease Management; Humans; Jaundice; Male; Middle Aged; Pallor; Prognosis; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

A 15-year-old boy on a vegetarian diet presented with severe macrocytic anaemia (haemoglobin, 5.1 g/dL; mean corpuscular volume, 116 fL) in addition to leucopenia and thrombocytopaenia (pancytopenia), icterus secondary to haemolysis and splenomegaly. Laboratory investigations revealed severe vitamin B12 (cobalamin) deficiency. Following cobalamin replacement therapy, the patient reported increased well-being, including appetite and weight gain, and his icterus resolved. In the follow-up laboratory examinations, leucocyte and platelet counts in addition to serum bilirubin and lactate dehydrogenase levels normalised. At the end of 2 months, laboratory findings, including haemoglobin level, were all within the normal range. We present this case as a reminder that severe vitamin B12 deficiency may present with findings mimicking acute leukaemia (pancytopenia and splenomegaly) and findings suggestive of pseudothrombotic microangiopathy.

Topics: Adolescent; Anemia, Macrocytic; Diagnosis, Differential; Hemolysis; Humans; Jaundice; Male; Pancytopenia; Splenomegaly; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

A previously healthy 66-year-old women presented with onset of general weakness, shortness of breath and significant weight loss. Due to appearance of jaundice, biliary obstruction had been ruled out by a CAT scan previous to the patients presentation in our practice.. The laboratory tests already arranged by the patients general practitioner showed a pronounced pancytopenia with megaloblastic anemia and hyperbilirubinemia. The bone marrow aspiration revealed a hypercellular bone marrow with megaloblastic erythropoiesis. The diagnosis of pernicious anemia was confirmed by the low cobalamin (vitamin B12) serum level and the presence of atrophic gastritis.. Pernicious anemia was treated with intramuscular injection of Cyanocobalamin (1000 µg) which resulted in an immediate reticulocytosis and a widely normalized blood cell count and bilirubin level four weeks after initiation of treatment.. The differential diagnosis of megaloblastic anemia covers a wide spectrum of diseases with different etiology. This case report demonstrates an example of a pernicious anemia with atypical and foudroyant clinical course.

Topics: Aged; Anemia, Macrocytic; Autoimmune Diseases; Biopsy; Bone Marrow; Diagnosis, Differential; Erythrocyte Indices; Female; Gastritis, Atrophic; Gastroscopy; Humans; Infusions, Intravenous; Jaundice; Megaloblasts; Pancytopenia; Ultrasonography; Vitamin B 12

Topics: Adult; Ataxia; Dementia; Humans; Jaundice; Male; Nervous System Diseases; Recurrence; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Approximately 15% of people aged more than 60 years old have a cobalamin (vitamin B12) deficiency, mainly in relation with food-cobalamin malabsorption (FCM). To date, no study has documented this disorder in the elderly. There is also little information on clinical consequences.. We studied 92 elderly patients with well-established FCM who were extracted from an observational cohort study (1995-2004) of 172 consecutive elderly patients with documented cobalamin deficiency.. The median patient age was 76 +/- 8 years; 60 patients were women. The most common clinical manifestations were neurologic or psychologic: mild sensory polyneuropathy (44.6%), confusion or impaired mental functioning (22.8%), and physical asthenia (20.7%). Hematologic abnormalities were reported in at least one third of the patients: anemia (21%), leukopenia (10.9%), thrombopenia (8.7%), and pancytopenia (6.5%). All patients had low serum vitamin B12 levels (<200 pg/mL), with a mean value (+/- standard deviation) of 131 +/- 38 pg/mL and total serum homocysteine level of 22.1 +/- 9.3 micromol/L. The mean hemoglobin level was 10.9 +/- 2.5 g/dL and the mean erythrocyte cell volume 95.7 +/- 12.7 fL. Correction of the serum vitamin B12 levels and hematologic abnormalities was achieved equally well in patients treated with either intramuscular or oral crystalline cyanocobalamin.. This study suggests that in elderly patients, FCM may be associated with significant neurologic, psychologic, and hematologic abnormalities, which seem to respond equally well to either oral or parenteral vitamin B12 therapy.

Topics: Aged; Aged, 80 and over; Asthenia; Cognition Disorders; Cohort Studies; Confusion; Edema; Erythrocyte Indices; Female; Follow-Up Studies; Gastritis, Atrophic; Hematologic Diseases; Hemoglobins; Homocysteine; Humans; Jaundice; Malabsorption Syndromes; Male; Paresthesia; Polyneuropathies; Reflex, Abnormal; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Cholestasis; Heart Failure; Hepatitis; Humans; Jaundice; Liver Cirrhosis; Myocardial Infarction; Pulmonary Heart Disease; Vitamin B 12

Topics: Alcoholism; Anemia; Anemia, Hypochromic; Avitaminosis; Cholestyramine Resin; Common Bile Duct; Diet; Diet Therapy; Diuretics; Folic Acid; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Humans; Hydrochlorothiazide; Ion Exchange Resins; Jaundice; Liver Cirrhosis; Liver Cirrhosis, Biliary; Postoperative Complications; Prothrombin Time; Vitamin B 12; Vitamin B Complex; Vitamin K

Topics: Blood; Chemical and Drug Induced Liver Injury; Chlorpromazine; Cholangitis; Diagnosis; Hepatitis; Hepatitis A; Humans; Jaundice; Jaundice, Obstructive; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Monoamine Oxidase Inhibitors; Prognosis; Vitamin B 12

Topics: Chemical and Drug Induced Liver Injury; Cobalt Isotopes; Hepatitis; Hepatitis A; Humans; Jaundice; Jaundice, Obstructive; Liver Diseases; Liver Function Tests; Toxicology; Vitamin B 12

Topics: Hematinics; Jaundice; Jaundice, Obstructive; Transaminases; Vitamin B 12

Topics: Blood; Hepatitis; Hepatitis A; Humans; Jaundice; Jaundice, Obstructive; Liver Cirrhosis; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Gastric Juice; Hematinics; Jaundice; Vitamin B 12