Vitamin B12 Deficiency
Patient’s Problem
Mrs. Krisna (name changed to protect identity), a 52-year-old school teacher, had six months of fatigue, numbness in her feet, poor concentration, and burning in her legs. She noticed a smooth, sore tongue and shortness of breath. With diabetes, long-term metformin use, a vegetarian diet, and gastritis, she was advised to see an MD physician in Vadodara.
Diagnosis
Based on her symptoms, examination, and lab findings, she was diagnosed with Vitamin B12 deficiency, causing macrocytic anemia and early peripheral neuropathy.
Findings included:
Physical Exam:
She appeared pale and mildly fatigued. Her tongue looked smooth and red (glossitis). She had reduced vibration sense and mild tingling in both feet.
Lab Tests:
Her hemoglobin was low at 9.8 g/dL, and her MCV was elevated at 112 fL, indicating macrocytic anemia.
Vitamin B12 levels were significantly low (112 pg/mL).
Both MMA and homocysteine were elevated, supporting the diagnosis.
Folate, WBC, platelets, and thyroid levels were normal.
Risk Factors Identified:
- Long-term metformin use
- A vegetarian diet low in B12
- Chronic gastritis
Treatment
Mrs. Krisna was started on Vitamin B12 replacement therapy under medical supervision.
Vitamin B12 Therapy:
Replacement was initiated based on the degree of anemia and nerve-related symptoms.
Addressing Contributing Factors:
Her metformin use and gastritis were reviewed, and she was advised to undergo regular monitoring of B12 levels.
She received dietary counselling to include more B12-rich foods like dairy, fortified cereals, and eggs.
Supportive Management:
Her fatigue levels and neuropathy symptoms were monitored over follow-up visits.
Repeat blood tests were scheduled to track improvement, a common approach followed by the best MD physicians in Vadodara.
Result
After three months, her hemoglobin rose to 12.1 g/dL, and MCV normalized. Her energy improved, and foot numbness reduced, though full nerve recovery will take longer. She continues B12 maintenance and dietary changes. Prognosis is excellent with timely treatment.
