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    Assignment onAssignment on

    Cobalt DeficiencyCobalt Deficiency

    VCMVCM--512512

    SUBMITTEDTOSUBMITTEDTO--

    DR.H.K.MEHTA SIDR.H.K.MEHTA SIRR

    SUBMITTED BY-

    R.G.VERMA

    ROLL NO.- 2809

    BATCH- A

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    Vitamin B12 isVitamin B12 is

    Also known as cobalaminAlso known as cobalamin

    Related to blood deficiency diseasesRelated to blood deficiency diseases

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    What does it do?What does it do?

    Manufactures red blood cells (RBC)Manufactures red blood cells (RBC)

    Aids in tissue growthAids in tissue growth

    Allows body to use certain nutrientsAllows body to use certain nutrients

    Facilitates numerous chemical reactionsFacilitates numerous chemical reactions

    Animals body normally containsAnimals body normally contains

    50005000--10 00010 000g vitamin B12g vitamin B12

    A healthy animal needs 3A healthy animal needs 3--55g per dayg per day

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    Which Foods are rich in B12?Which Foods are rich in B12?

    Animal products (meat, fish, poultry)Animal products (meat, fish, poultry)

    Not usually denatured by cookingNot usually denatured by cooking

    Great sources: liver, kidneyGreat sources: liver, kidney

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    High Risk DietsHigh Risk Diets

    Some nutrients only occur in animalSome nutrients only occur in animalproductsproducts

    Major concern is that B12 comes fromMajor concern is that B12 comes frombacteria (which is only found in meatbacteria (which is only found in meat

    products)products)

    Restricting diet makes it difficult to get allRestricting diet makes it difficult to get all

    nutrientsnutrients

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    Other CausesOther Causes

    Low intestinal B12 uptakeLow intestinal B12 uptake

    Low intrinsic factor in the stomachLow intrinsic factor in the stomach

    Deficiency ofHCl in gastric juicesDeficiency ofHCl in gastric juices

    LaxativesLaxatives

    Low uptake in CNSLow uptake in CNS

    Lack of calciumLack of calcium

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    Consequences of Deficiency:Consequences of Deficiency:

    a variety of conditions may occur:a variety of conditions may occur:

    anemiaanemia

    FatigueFatigue Nerve damagedNerve damaged

    Smooth tongueSmooth tongue

    Sensitive skinSensitive skin

    Loss of memory, exhaustion, loss of muscleLoss of memory, exhaustion, loss of muscle

    strengthstrength

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    Folic AcidFolic Acid

    Can mask B12Can mask B12

    deficiencydeficiency

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    B12 and SleepB12 and Sleep

    Can help those with sleep disordersCan help those with sleep disorders

    Releases Melatonin (sleep hormone)Releases Melatonin (sleep hormone)

    Works in presence of sunlig

    ht and is

    Works in presence of sunlig

    ht and isbeneficial to jetlagbeneficial to jetlag

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    DiagnosisDiagnosis

    SerumSerum BB1212 levels are often low in Blevels are often low in B1212 deficiency,deficiency,

    but if other features of Bbut if other features of B1212 deficiency are presentdeficiency are present

    with normal Bwith normal B1212 then the diagnosis must not bethen the diagnosis must not be

    discounted. One possible explanation for normaldiscounted. One possible explanation for normalBB1212 levels in Blevels in B1212 deficiency is antibody interferencedeficiency is antibody interference

    in people withhighin people withhigh titrestitres ofofintrinsic factorintrinsic factor

    antibodyantibody.. Some researchers propose that theSome researchers propose that the

    current standard norms of vitamin Bcurrent standard norms of vitamin B1212 levels arelevels are

    too low.too low. In Japan, the lowest acceptable level forIn Japan, the lowest acceptable level for

    vitamin Bvitamin B1212 in blood has been raised from aboutin blood has been raised from about

    200 pg/ml (145200 pg/ml (145 pMpM) to 550 pg/ml (400) to 550 pg/ml (400 pMpM).).[[

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    There is confusion in units of BThere is confusion in units of B1212 deficiencydeficiency

    when given by various labs in variouswhen given by various labs in variouscountries.Where units are presented ascountries.Where units are presented as

    pg/liter, or pg/L, they are likely in error.pg/liter, or pg/L, they are likely in error.[[citationcitation

    neededneeded]]Where they are presented as pg/Where they are presented as pg/mLmL

    oror pmolpmol/L, they are likely correct. The/L, they are likely correct. The

    ranges for these two units are similar, sinceranges for these two units are similar, since

    the molecular weight of Bthe molecular weight of B1212 is approximatelyis approximately

    1000, the difference between1000, the difference between mLmL and L.and L.Thus: 550 pg/Thus: 550 pg/mLmL = 400= 400 pmolpmol/L.s/L.s

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    SerumSerum HomocysteineHomocysteine andand MethylmalonicMethylmalonic acidacid

    levels are considered more reliable indicators oflevels are considered more reliable indicators of

    BB1212 deficiency than the concentration of Bdeficiency than the concentration of B1212 ininblood, see for example research at theblood, see for example research at the St. LouisSt. Louis

    UniversityUniversity..[29][29] The levels of these substances areThe levels of these substances are

    high in Bhigh in B1212 deficiency and can be helpful if thedeficiency and can be helpful if the

    diagnosis is unclear. Approximately 10% ofdiagnosis is unclear. Approximately 10% ofpatients with vitamin Bpatients with vitamin B1212 levels between 200levels between 200

    400pg/l will have a vitamin B400pg/l will have a vitamin B1212 deficiency on thedeficiency on the

    basis of elevated levelsbasis of elevated levels

    ofofhomocysteinehomocysteine andand methylmalonicmethylmalonic acidacid..[[citationcitationneededneeded

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    Routine monitoring ofRoutine monitoring ofmethylmalonicmethylmalonic acidacid levels inlevels in

    urine is an option for people who may not beurine is an option for people who may not be

    getting enough dietary Bgetting enough dietary B1212, as a rise, as a rise

    ininmethylmalonicmethylmalonic acidacid levels may be an earlylevels may be an early

    indication of deficiency.indication of deficiency.[30][30]

    If nervous system damage is suspected,If nervous system damage is suspected,BB1212 analysis inanalysis in cerebrospinal fluidcerebrospinal fluid can also becan also be

    helpful, though such an invasive test would behelpful, though such an invasive test would be

    applicable only after unrevealing blood testing.applicable only after unrevealing blood testing.[31][31]

    TheThe Schilling testSchilling test can play a role in the diagnosis.can play a role in the diagnosis.

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    TreatmentsTreatments

    Oral supplementsOral supplements low success ratelow success rate

    Intramuscularly proven more successfulIntramuscularly proven more successful

    Active form is most successfulActive form is most successful Must be supplied with folic acidMust be supplied with folic acid

    Fish should be emphasized in dietFish should be emphasized in diet

    6 months6 months one year to recoverone year to recover

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    Vitamin BVitamin B1212 can be given as intramuscular orcan be given as intramuscular or

    subcutaneous injectionssubcutaneous injections

    ofofhydroxycobalaminhydroxycobalamin,, methylcobalaminmethylcobalamin,,

    ororcyanocobalamincyanocobalamin. Body stores (in the liver) are. Body stores (in the liver) are

    partlypartly repletedrepleted withhalf a dozen injections in thewithhalf a dozen injections in the

    first couple of weeks (full repletion of liver storesfirst couple of weeks (full repletion of liver stores

    requires about 20 injections) and thenrequires about 20 injections) and then

    maintenance with monthly injections throughoutmaintenance with monthly injections throughout

    the life of thethe life of the patientpatient. Vitamin B. Vitamin B1212 can also becan also be

    easily selfeasily self--administered by injection by the patient,administered by injection by the patient,

    using the same fineusing the same fine--gauge needles and syringesgauge needles and syringes

    used for selfused for self--administration ofadministration ofinsulininsulin..

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