Salih Ehsan: The Deceptive Nature of B12 Deficiency Not Just Anemia
Salih Ehsan, Chief Executive Officer at Kulsoom Society of Hematology, shared Abdul Mannan’s post on LinkedIn:
”I always said to my junior that B12 has 12 faces like Tuberculosis, in every new patient of B12 deficiency, it will teach you a new lesson.
Each and every cell need it but cells with faster division (blood, skin, mucus membrane) have high demand that why they have set pattern of signs and symptoms.
Cells with slow progress and low demand have weird symptoms . B12 is my favorite teacher it’s give me a new lesson everyday.
Whenever I get confident about B12, it surprise me.
It can mimicker of migraine and Depression, can mimic chronic diarrhea and persistent vomiting.
It’s can mimic hemolytic anemia and jaundice too , it’s can become partner of IDA and turn the table of CBC pattern (from microcytic to normocytic).
From beginning of my practice, I love IDA to diagnose and treat but B12 deficiency gradually attain my attention and respect.”
Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
”B12 deficiency doesn’t announce itself. That’s what makes it dangerous.
I’ve seen it fool trainees, registrars, and yes, consultants too. It’s not a simple diagnosis.
It’s a shape-shifter.
Here’s what every doctor needs to know:
- On the blood film, it can look exactly like leukaemia. Hypersegmented neutrophils, a leukoerythroblastic picture, giant metamyelocytes.
- A bone marrow biopsy is sometimes done before anyone checks B12.
- In the clinic, it can feel like motor neurone disease.
- Weakness, spasticity, sensory loss. Subacute combined degeneration of the cord is real and it’s irreversible if you miss it.
The Hb can be completely normal.
The neurological damage can be well underway while the FBC looks reassuring.
A normal MCV does not rule out B12 deficiency.
Serum B12 alone is unreliable.
Levels can sit in the low-normal range while the patient is functionally deficient.
Active B12 (holotranscobalamin), MMA, and homocysteine are far better when you’re in doubt.
The moment B12 deficiency crosses your mind as a possibility, treat it.
The treatment is cheap, safe, and the downside of treating unnecessarily is essentially zero.
The downside of waiting is a patient who doesn’t recover.
Think of it early.
Treat it without hesitation.
What’s the most unusual presentation of B12 deficiency you’ve come across?”
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