RT Book, Section
A1 Zehnder, James L.
A2 Katzung, Bertram G.
A2 Trevor, Anthony J.
SR Print(0)
ID 1104846287
T1 Agents Used in Cytopenias; Hematopoietic Growth Factors
T2 Basic & Clinical Pharmacology, 13e
YR 2015
FD 2015
PB McGraw-Hill Medical
PP New York, NY
SN 9780071825054
LK accesspharmacy.mhmedical.com/content.aspx?aid=1104846287
RD 2021/01/24
AB CASE  STUDYA  65-year-old  woman  with  a  long-standing  history  of  poorly  controlled  type  2  diabetes  mellitus  presents  with  increasing  numbness  and  paresthesias  in  her  extremities,  generalized  weakness,  a  sore  tongue,  and  gastrointestinal  discomfort.*  Physical  examination  reveals  a  frail-looking,  pale  woman  with  diminished  vibration  sensation,  diminished  spinal  reflexes,  and  a  positive  Babinski  sign.  Examination  of  her  oral  cavity  reveals  atrophic  glossitis,  in  which  the  tongue  appears  deep  red  in  color  and  abnormally  smooth  and  shiny  due  to  atrophy  of  the  lingual  papillae.  Laboratory  testing  reveals  a  macrocytic  anemia  based  on  a  hematocrit  of  30%  (normal  for  women,  37–48%),  a  hemoglobin  concentration  of  9.4  g/dL  (normal  for  elderly  women,  11.7–13.8  g/dL),  an  erythrocyte  mean  cell  volume  (MCV)  of  123  fL  (normal,  84–99  fL),  an  erythrocyte  mean  cell  hemoglobin  concentration  (MCHC)  of  34%  (normal,  31–36%),  and  a  low  reticulocyte  count.  Further  laboratory  testing  reveals  a  normal  serum  folate  concentration  and  a  serum  vitamin  B12  (cobalamin)  concentration  of  98  pg/mL  (normal,  250–1100  pg/mL).  Results  of  a  Schilling  test  indicate  a  diagnosis  of  pernicious  anemia.  Once  megaloblastic  anemia  was  identified,  why  was  it  important  to  measure  serum  concentrations  of  both  folic  acid  and  cobalamin?  Should  this  patient  be  treated  with  oral  or  parenteral  vitamin  B12?