How I treat cobalamin (vitamin B12) deficiency

被引:210
作者
Carmel, Ralph [1 ,2 ]
机构
[1] New York Methodist Hosp, Dept Med, Brooklyn, NY 11215 USA
[2] Cornell Univ, Weill Med Coll, New York, NY 10021 USA
基金
美国国家卫生研究院;
关键词
D O I
10.1182/blood-2008-03-040253
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor-driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose. The virtues of these principles are not always fully appreciated. Recent developments have made diagnosis and management more difficult by diminishing the ability to determine cobalamin absorption status. Clinicians must also grapple with premature medicalization of isolated, mild biochemical changes that added many asymptomatic cases of still undetermined medical relevance to their caseload, often expanded by inflated cobalamin level criteria. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. Pathophysiologically based management requires systematic attention to each of its individual components: correctly diagnosing cobalamin deficiency, reversing it, defining its underlying cause, preventing relapse, managing the underlying disorder and its complications, and educating the patient.
引用
收藏
页码:2214 / 2221
页数:8
相关论文
共 72 条
[1]   DIAGNOSIS OF COBALAMIN DEFICIENCY .1. USEFULNESS OF SERUM METHYLMALONIC ACID AND TOTAL HOMOCYSTEINE CONCENTRATIONS [J].
ALLEN, RH ;
STABLER, SP ;
SAVAGE, DG ;
LINDENBAUM, J .
AMERICAN JOURNAL OF HEMATOLOGY, 1990, 34 (02) :90-98
[2]   Vegetarianism and vitamin B-12 (cobalamin) deficiency [J].
Antony, AC .
AMERICAN JOURNAL OF CLINICAL NUTRITION, 2003, 78 (01) :3-6
[3]  
BERLIN H, 1968, ACTA MED SCAND, V184, P247
[4]   Allergy to vitamin B12: two cases of successful desensitization with cyanocobalamin [J].
Caballero, M. R. ;
Lukawska, J. ;
Lee, T. H. ;
Dugu, P. .
ALLERGY, 2007, 62 (11) :1341-1342
[5]   TREATMENT OF SEVERE PERNICIOUS-ANEMIA - NO ASSOCIATION WITH SUDDEN-DEATH [J].
CARMEL, R .
AMERICAN JOURNAL OF CLINICAL NUTRITION, 1988, 48 (06) :1443-1444
[6]   IRON-DEFICIENCY OCCURS FREQUENTLY IN PATIENTS WITH PERNICIOUS-ANEMIA [J].
CARMEL, R ;
WEINER, JM ;
JOHNSON, CS .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1987, 257 (08) :1081-1083
[8]   NUTRITIONAL VITAMIN-B12 DEFICIENCY - POSSIBLE CONTRIBUTORY ROLE OF SUBTLE VITAMIN-B12 MALABSORPTION [J].
CARMEL, R .
ANNALS OF INTERNAL MEDICINE, 1978, 88 (05) :647-649
[9]   Prevalence of undiagnosed pernicious anemia in the elderly [J].
Carmel, R .
ARCHIVES OF INTERNAL MEDICINE, 1996, 156 (10) :1097-1100
[10]   MALABSORPTION OF FOOD COBALAMIN [J].
CARMEL, R .
BAILLIERES CLINICAL HAEMATOLOGY, 1995, 8 (03) :639-655