A SEVEN‐YEAR STUDY OF VITAMIN B12 DEFICIENCY EXCLUSIVE OF MACROCYTIC ANEMIA: PRELIMINARY REPORT
Published Dec 1, 1960 · H. Bakke
Journal of the American Geriatrics Society
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Abstract
Vitamin B12 deficiency, as distinct from neglected cases of so-called pernicious anemia, is well known but appears to be treated in haphazard fashion. The early symptoms vary so widely that it is difficult to make a diagnosis in the beginning stages of the disease. The diagnosis previously had been missed in the 4 patients reported here. The first one of these presented a particularly difficult diagnostic problem which finally was solved because of the similarity between the symptoms and the central nervous signs of pernicious anemia. The diagnosis, although made late, together with appropriate treatment saved the patient's life. Vitamin B12 deficiency affects persons in older age groups. Remissions are the rule and therefore the effect of a therapeutic trial with vitamin Bl 2 is difficult to evaluate. Elderly people are likely to have other complicating disease, and many of them are prone to accept the vitamin deficiency as a part of the process of aging. Physical and laboratory examinations are of little or no value in establishing the diagnosis. The history alone offers a clue. It was necessary to screen approximately 100 patients over a period of several years before a pattern for the symptoms of vitamin B12 deficiency could be established. Then it was found that the pattern was applicable only to advanced cases and to patients in an invalid classification. The triad of symptoms upon which a tentative diagnosis in the late, or invalid, stage may be made are: 1) chronic vertigo, 2) sudden or temporary loss of control of a limb with muscle weakness, and 3) some form of paresthesia. The diagnosis is confirmed when clear-cut improvement occurs within two to six weeks after commencing the injection of 500 p.g. of aqueous crystalline vitamin B12 at weekly intervals, provided no relapse occurs after six months of treatment. Patient S. M. B. (see Case Report) responded to the parenteral administration of vitamin B12, but because of the late stage of the disease at the time the vitamin was first given, he was left with some residual impairment. The other 3 patients, in whom the diagnosis was made at an earlier stage, responded to the vitamin and had no after-effects. They were in the invalid stage but the disease was not far advanced. Two of them had mental aberrations, and 2 had severe abdominal distress. With treatment, the 1 male and 2 females in this group have remained in reasonably good health. The following is an abstract of the history of the first patient.