| Vitamins Needed | ||
| Methyl Malonic Acid—–> | B12 | —–>Succinyl CoA |
| Homocysteine—–> | B12 Folate Pyridoxine | —–>Methionine |
From above table, we can understand that Both Methyl Malonic acid and Homocysteine will go up in B12 deficiency.
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Here are some differences to help in the differential diagnosis:
| B12 Deficiency | MDS | |||
| Smooth & bald tongue, cheilosis, hyperpigmentation Intramedullary destruction, SACD | Elderly patient with low Blood cells [RBC, WBC and or Platelets] | |||
| Oval Macrocytes | Oval Macrocytes | |||
| Megaloblasts | Megakaryocytes | |||
| Hypersegmented PMN | Hyposegmented PMN | |||
| Hypercellular Marrow | Hypercellular Marrow |
Megakaryocytes are also seen Aplastic anemia [Hypocellular marrow], ITP, Essential thrombocytosis, Marrow fibrosis [Dysmorphic megakaryocytes]
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Thrombotic Thrombocytopenic Purpura [TTP]. Tip to remember the Pentad: Neuro Renal FAT
- Neurological Symptoms
2. Renal issues
3. Fever
4. Anemia by hemolysis
5. Thrombocytopenia
-Adamts 13 protein deficiency
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Schistocytes =Fragmented RBCs
These are seen in
HUS
HELPP
TTP
DIC
Tip to remember: [Who’s helping that dick?] =HUS HELLP TTP DIC.
HUS->AKI after bloody diarrhea after eating meat with EColi O157:H7, It is atypical HUS if it happens without Diarrhea.
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Vaccines that should be given prior to Splenectomy:
Tip to remember: PIMP hem before Splenectomy
PCV13
Influenza
Meningococcal
Pneumovax 23
Hemophilus Influenza Type B
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Itching after shower is seen in:
Polycythemia vera
NHL
Myelofibrosis
.
Patient feeling better with shower:
Marijuana abuser
