Clinical Quiz About Vitamin B12 Deficiency

A 42-year-old woman presents with pins and needles in her hands and feet. She incidentally describes weight loss and offensive smelling stool. She has a history of diverticular disease and anaemia. She is a non-smoker and non-drinker. She eats red meat. On examination, the power and tone in her legs are normal. There are exaggerated knee jerks and absent ankle jerks. Joint position and vibration sense are absent below her ankles. The plantar responses are extensor.

Investigation results:

Haemoglobin (Hb) 10.3 g/dl
Whole blood count (WBC) 5.0 × 109/l
Platelets 142× 109/l
Mean cell volume (MCV) 107 fL
Bilirubin 32 μmol/l
Alanine aminotransferase (ALT) 22 U/l (5–35)
Alkaline phosphatase (ALP) 45 U/l (30–150)
Albumin 35 glL

Blood film Macrocytosis and hypersegmented neutrophils
Ferritin 46 μg/l (4–120)
Serum B12 80 ng/l (160–900)
Folate 50 μg/l (3–20)

Schilling test:

Oral labelled vitamin B12 secreted in urine:

Pre intrinsic factor 3%
Post intrinsic factor 4%

What is the most likely diagnosis?

Terminal ileal Crohn’s disease

Chronic pancreatitis

Bacterial overgrowth

Pernicious anaemia

R-Binder deficiency

Answer 30/9/2010