Etiopathogenesis, Clinical Features, and Management of Vitamin B12 and Folate Deficiency Anemia

Introduction

Vitamin B12 and folate are crucial for DNA synthesis and red blood cell production. A deficiency can lead to anemia, causing a range of clinical manifestations affecting multiple organ systems.

Etiopathogenesis

Causes of Vitamin B12 Deficiency

• Dietary deficiency (vegetarian diet)
• Malabsorption syndromes (pernicious anemia, Crohn’s disease)
• Gastrointestinal surgeries (gastrectomy, ileal resection)
• Increased demand (pregnancy, chronic diseases)

Causes of Folate Deficiency

• Inadequate dietary intake
• Alcoholism
• Malabsorption conditions (celiac disease)
• Medications interfering with folate metabolism (methotrexate, phenytoin)

Clinical Manifestations of Vitamin B12 Deficiency Anemia

Neurological Symptoms

Vitamin B12 is essential for neurological function. Deficiency can lead to:

• Paresthesia and numbness
• Ataxia and loss of proprioception
• Cognitive impairment and memory loss

Hematological Features

Classic findings include:

• Megaloblastic anemia
• Hypersegmented neutrophils on blood smear
• Pancytopenia in severe cases

Gastrointestinal Symptoms

Patients may present with:

• Glossitis and oral ulcers
• Diarrhea or constipation
• Weight loss due to malabsorption

Diagnosis

Diagnostic workup includes:

• Complete blood count (CBC) showing macrocytosis
• Serum vitamin B12 and folate levels
• Methylmalonic acid and homocysteine assays

Management

Vitamin B12 Deficiency Treatment

• Parenteral vitamin B12 (intramuscular injections)
• Oral supplementation for mild cases

Folate Deficiency Treatment

• Dietary modification with folate-rich foods
• Folic acid supplementation

Conclusion

Timely recognition and management of Vitamin B12 and folate deficiency anemia are essential to prevent irreversible complications, particularly neurological impairment.