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PROPER DIAGNOSIS OF THE DISEASE AND FURTHER TREATMENT OF B12-
DEFICIENCY ANEMIA
Hasanov Alisher Yurievich
Khakimova Sohiba Ziyadulloevna
Samarkand State Medical University
https://doi.org/10.5281/zenodo.13904106
Abstract:
In 12-deficiency anemia, the syndrome of damage to the nervous system
dominates, which naturally forces them to seek help from a neurologist. In these cases, the
correct diagnosis of the disease and further treatment depend on the latter, since the hasty
administration of vitamin B12 very quickly leads to the disappearance of megaloblasts from the
bone marrow, which are a pathognomonic sign of percinous anemia. This makes it difficult to
recognize the true nature of neurological disorders. Unfortunately, it should be recognized that
to date, the neurological manifestations of B12-deficiency anemia have not been systematized
and do not have a clear description.
Keywords:
vitamin B12, anemia, neurological syndrome, bone marrow.
The aim of the study was to study the frequency and nature of neurological manifestations
of B12-deficiency anemia. 52 patients were observed, of which 30 (57%) had neurological
manifestations of funicular myelosis. Sensitivity disorders, changes in Achilles and knee
reflexes, and gait disorders were most often detected. The complete disappearance of
neurological manifestations of Vi-deficient anemia is possible only with a mild degree of
funicular myelosis.
Key words:
B12-deficiency anemia, funicular myelosis.
Materials and methods:
for 7 years, 52 patients with newly diagnosed B12 deficiency
anemia (20 men, 32 women, average age - 64.3 years) were examined together with
hematologists. The diagnosis was clinically verified and confirmed by a bone marrow punctate
examination. It should be specially noted that megaloblasts were found in all patients in the
bone marrow punctate. All patients underwent a thorough neurological examination, involving
electroencephalography (18 patients), electroneuromyography-graphy magnetic resonance or
computed tomography (10), esophagogastroduodenoscopy (29), if necessary. According to the
classification of P.M. Alperin and Yu.G. Miterev [1], anemia of mild severity (HH -110-90 g/l)
was present in 13 patients, moderate (HH-89-70 g/l) - in 29 and severe anemia (HH - 69 g/l
and below) - in 10 patients. It should be noted that among the examined patients there were no
strict vegetarians, patients who had undergone gastrectomy, suffering from Crohn's disease,
helminthic invasion (diphyllobothriosis), people taking medications for a long time
(aminosalicylic acid, neomycin, etc.), as well as those treated with vitamin B12 injections. This
made it possible to exclude the symptomatic nature of B12-deficient anemia and its
cytologically unconfirmed variants.
Results and their discussion.
When examining patients, the straw-yellow coloration of
the skin and sclera attracted attention (38; 73%). At the same time, the frequency of detection
of this symptom clearly increased with increasing severity of anemia. Normal div mass index
(18.5-24.9 kg/m2) was found in 29 patients, decreased (<18.5 kg/m2) in one, increased (>25.0
kg/m2) in 22 patients. This corresponds to the observations of L.I. Idelson [4] and generally
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indicates that exhaustion among patients with B12 deficiency anemia, despite the presence of
severe disease, is relatively rare.
Changes from the gastrointestinal tract were present in most patients and were quite
specific. Thus, complaints of severity or pain in the epigastric region, belching, nausea,
decreased appetite as subjective manifestations of atrophic gastritis were present in 37
(71.1%) patients. The latter was confirmed by esophagogastroduodenoscopy and mucosal
biopsy. Of particular note is the presence in some patients of glossitis (Gunther's tongue; 19;
36.5%) - a crimson-colored tongue with smoothed papillae ("varnished"). In some patients (8;
15.4%), in addition, there were areas of inflammation with erosions at the tip and edges of the
tongue. The spleen was palpated in 13 (25%) patients, and an increase in liver size was
observed in 10 (19.2%) patients. On the part of the cardiovascular system, there was an
expansion of the boundaries of relative cardiac dullness to the left (by 1-2 cm), a tendency to
tachycardia (average heart rate - 79.8 in 1 min) and arterial hypotension (110/70 -100/60
mmHg).
Hyperchromic (43; 82.7%), less often normochromic anemia (9; 17.3%), moderate
leukopenia and thrombocytopenia were usually detected in the blood of the examined patients.
On the part of erythrocytes, anisocytosis, macrocytosis and the presence of nuclear residues
(Jolly corpuscles and Kebot rings) were noted. The number of reticulocytes was reduced or
normal. Erythrocaryocytes were often detected. Irritation of the red germ was detected in the
bone marrow, and megaloblasts, a characteristic sign of percinous anemia, were also detected.
Based on the submitted complaints and the results of an objective neurological
examination, all patients were divided into 2 groups. Group 1 included 22 (43%) patients who
complained of general weakness, shortness of breath during exercise, fatigue, dizziness, i.e.
complaints characteristic of anemia, but they did not have subjective and objective signs
indicating damage to the nervous system. It should be noted that the majority of these patients
(18) initially turned to a therapist.
Group 2 included 30 (57%) patients who, along with the above complaints, also had
subjective and objective manifestations typical of funicular myelosis. It should be noted that if
patients of the 1st group complained of general weakness, then patients of the 2nd, as a rule,
added to this that they were mainly concerned about weakness in their legs and arms.
A comparison of patients in groups 1 and 2, depending on the severity of anemia, did not
reveal any pattern. Thus, anemia of mild severity was present in groups 1 and 2, respectively,
in 5 and 7 cases, moderate in 13 and 16, and severe anemia in 4 and 6 cases. A similar situation
has been noted by other researchers [1, 3, 4]. This suggests that the main role in the occurrence
of neurological manifestations of percinous anemia is played not so much by the severity of
anemia as by its duration. However, it is always difficult for a doctor to judge the duration of
this pathology. Usually, patients adapt well to gradually increasing anemia and turn to a doctor
when their compensatory capabilities are exhausted or when neurological disorders appear.
And further, as the above data indicate, the appearance of signs of damage to the nervous
system is not an obligate manifestation of B12-deficiency anemia. They occur only in 57% of
patients and, apparently, some additional conditions are necessary for their appearance, and
not only vitamin B deficiency itself. The frequency of subjective and objective neurological
disorders detected in 30 patients with percinous anemia is presented in
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Of particular interest are the patients of the 2nd group, among whom, by the way, 12
patients initially turned to a neurologist for help.
Conclusions:
It must be said that neurologists saw the unusual condition of the patient,
in which the neurological symptoms as a whole did not correspond to that characteristic of a
"banal" lesion of the nervous system. This forced them to refrain from the standard vitamin B12
prescription, continue the examination and eventually make the correct diagnosis.
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Allen L.H. How common is vitamin B-12 deficiency? // Am. J. Clin. Nutr. 2009. Vol. 89. №
2. P. 693–696.
3.
Antony A.C. Vegetarianism and vitamin B-12 (cobalamin) deficiency // Am. J. Clin. Nutr.
2003. Vol. 78. № 1. P. 3–6.
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Garcia A., Zanibbi K. Homocysteine and cognitive function in elderly people // CMAJ. 2004.
Vol. 171. № 8. P. 897–904.
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