|Methyl Malonic Acid—–>||B12||—–>Succinyl CoA|
From above table, we can understand that Both Methyl Malonic acid and Homocysteine will go up in B12 deficiency.
Here are some differences to help in the differential diagnosis:
|Smooth & bald tongue, cheilosis, hyperpigmentation|
Intramedullary destruction, SACD
|Elderly patient with low Blood cells [RBC, WBC and or Platelets]|
|Oval Macrocytes||Oval Macrocytes|
|Hypersegmented PMN||Hyposegmented PMN|
|Hypercellular Marrow||Hypercellular Marrow|
Megakaryocytes are also seen Aplastic anemia [Hypocellular marrow], ITP, Essential thrombocytosis, Marrow fibrosis [Dysmorphic megakaryocytes]
Thrombotic Thrombocytopenic Purpura [TTP]. Tip to remember the Pentad: Neuro Renal FAT
- Neurological Symptoms
2. Renal issues
4. Anemia by hemolysis
-Adamts 13 protein deficiency
Schistocytes =Fragmented RBCs
These are seen in
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.
Vaccines that should be given prior to Splenectomy:
Tip to remember: PIMP hem before Splenectomy
Hemophilus Influenza Type B
Itching after shower is seen in:
Patient feeling better with shower: