- low cobalamin level ( normally it’s > 301 pg ( 155 pmol/ l ) when defcity is asymptomatic = < 170 pg/ml
Symptomatic = < 100 pg/ ml
- elevated level of mythylmalonic acid
- moderate to severe with MCV quite elevated (100-140fl).
- in severe cases Reduced reticulocyte wbs & platelet
- vit B12 vs folic acid deficity >>> RBC folic acid is lower in FA .
- vit B12 vs mylodysplastic syndrom >>> by morphology & low cobalamin + high mythylmalonic acid
Initially by parental therapy > can be replaced with Oral or sublingual methylcobalamine (1mg/day)
Intramuscular or subcutaneous injec of 100mcg of vitamin B12 are adequate for each dose. Replacement is usually given daily first week, weekly for the next month and monthly for life.