Which symptoms are associated with B12 deficiency Anemia?

1.

Koppel, Barbara S., Weimer, Louis H., Daras, Michael (2024). In Goldman-Cecil Medicine (pp. 2537). DOI: 10.1016/B978-0-323-93038-3.00384-1

Demyelination of the dorsal columns causes proprioceptive loss that can result in sensory ataxia owing to loss of position sense in the feet. A positive Romberg sign (failure to maintain balance only after the eyes are closed) distinguishes sensory from cerebellar ataxia. A non–length-dependent axonal peripheralneuropathycausing numbness and tingling in the hands and feet is often present, but spinal cord disease is more prominent and less amenable to recovery. Motor nerve function eventually becomes impaired as well. The optic nerve is the most commonly involved cranial nerve, but vagal neuropathy also can occur. Signs of cerebral involvement include memory loss, personality changes, and occasionally hallucinations and psychosis. Although encephalopathy and dementia may be present, B12deficiency may be a secondary phenomenon in a patient with another cause of memory impairment, or both conditions may coexist without a causative relationship. Neurologic abnormalities may precede or be present without anemia, although the anemia is severe in 20% of patients with vitamin B12deficiency. Symptoms generally progress slowly, but they can appear rapidly after exposure to nitrous oxide anaesthesia in individuals who have preexisting subclinical cobalamin deficiency.

2.

Elsevier ClinicalKey Clinical Overview

Diagnosis Anemia develops slowly; patient usually remains asymptomatic until anemia is severe May come to attention from low hemoglobin or hematocrit or elevated mean corpuscular volume on routine CBC If tissue hypoxia is present, typical symptoms common to any severe anemia will be present Fatigue Weakness Lightheadedness Exertional dyspnea Palpitations Poor endurance Symptoms of underlying cause may be present Vitamin B₁₂ and/or folate deficiency Body stores of folate are limited and last only for a few months, whereas body stores of vitamin B₁₂ may last years after intake or absorption decreases; thus, symptoms of vitamin B₁₂ deficiency may be delayed Newborns and infants may have nonspecific manifestations, including weakness, irritability, lethargy, feeding difficulties, vomiting and diarrhea, and failure to thrive Glossalgia (tongue discomfort) Neurologic symptoms of B₁₂ deficiency Symmetrical distal numbness and tingling Unsteady gait Limb weakness Neuropsychiatric symptoms Mild forgetfulness Subtle behavioral changes Confusion Memory loss Paranoia Hallucinations and delusions Neurologic symptoms of folate deficiency are subtle and uncommon Mild cognitive decline Depression (with significant folate deficiency) Liver disease (alcoholic or nonalcoholic) Fatigue and weakness may be multifactorial Anorexia, weight loss, nausea, vomiting, and/or bloating Right upper quadrant pain If cirrhosis is present, symptoms of hepatic encephalopathy (eg, confusion) may manifest Hypothyroidism Cold intolerance Fatigue, generalized weakness Slight weight gain Constipation Menstrual irregularity Historical clues to underlying cause of macrocytic anemia may be present Alcohol use disorder Vegetarian or vegan diet Ingestion of raw fish

3.

Vitamin Deficiency (Hypovitaminosis), Elsevier ClinicalKey Derived Clinical Overview

• Vitamin B12(cyanocobalamin): 1.000000000000000e+00 Megaloblastic anemia (pernicious anemia) 2.000000000000000e+00 Neurologic symptoms including peripheral neuropathy, ataxia (shuffling gait), paresthesia; subacute degeneration of the spinal cord (demyelination of the dorsal column), visual disturbances due to optic atrophy 3.000000000000000e+00 Glossitis and GI symptoms such as nausea, vomiting, and anorexia are also common 4.000000000000000e+00 Patients may also have dementia/mental sluggishness, depression, and weakness • Vitamin B9(folic acid): 1.000000000000000e+00 Patchy hyperpigmentation of skin (especially between fingers and toes) and mucous membranes 2.000000000000000e+00 Moderate fever (temp <102° F; 38.9° C) despite the absence of infection 3.000000000000000e+00 Neural tube defect 4.000000000000000e+00 Angular stomatitis 5.000000000000000e+00 Red, beefy, smooth, and shiny tongue 6.000000000000000e+00 Megaloblastic anemia • Vitamin C: Scurvy (bruising, petechiae, follicular hyperkeratosis, perifollicular hemorrhage, corkscrew hairs), poor wound healing, fatigue, gingivitis/bleeding gums, weight loss, bone abnormalities (Fig. E2). Also, loss of teeth, abnormal nail (koilonychia and splint hemorrhages). Vitamin C deficiency may be associated with nonalcoholic fatty liver FIG. E2Scurvy.The knee shows widened metaphyses with spurs and reduced bone density. The ossific centers have a typical “white pencil” outline.