Avtor/Urednik		Mlakar, Uroš
Naslov		Diagnostika pomanjkanja vitamina B12 in folatov
Prevedeni naslov		Diagnosis of vitamin B12 and folate deficiency
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 39, št. Suppl 7
Leto izdaje		2000
Obseg		str. 41-5
Jezik		slo
Abstrakt		The evaluation of suspected cobalamin (vitamin B12) or folate deficiency generally proceeds in three stages:1) recognizing that megaloblastic anaemia is present, 2) documenting the presence of cobalamin or folate deficiency and 3) determining its cause. The megaloblasic anaemia is established by evaluating the complete blood count and blood smear with characteristic macroovalocytes and hypersegmented neutrophils. Bone marrow examination is usually unnecessary. Answer whether cobalamin or folate deficiency is responsible for megaloblastic anaemia can be obtained by serum cobalamin and serum folate levels. Additional testing of serum methylmalonic acid and total serum homocysteine is recommended for interpreting borderline cobalamin and folate levels, to rule out cobalamin deficiency when both cobalamin and folate levels are low, and in conditions known to perturb cobalamin and folate tests. In most cases the last step in evaluation of cobalamin and folate deficiency involves identifying pernicious anaemia by evaluation of cobalamin absorption with Schilling test.
Izvleček		Ugotavljanje pomanjkanja vitamina B12 in folatov začnemo s kliničnim pregledom. Šele na osnovi izsledkov pregleda, se odločimo za nadaljnje preiskave. Te lahko razdelimo v tri skupine: preiskave za ugotovitev megaloblastne anemije, preiskave za ugotovitev pomanjkanja folatov ali vitamina Bl2 in preiskave za ugotovitev vzroka pomanjkanja. Megaloblastno anemijo ugotovimo s pregledom celotne krvne slike. Pomembna je prisotnost megalocitov in hipersegmentiranih nevtrofilcev. Citološki pregled kostnega mozga pogosto ni potreben. Pomanjkanje vitamina B12 ali folatov ugotovimo s določitvijo njihove koncentracije v serumu. Dodatna določitev koncentracije metilmalonične kisline in celotnega homocisteina v serumu nam je v pomoč pri mejnih vrednostih vitamina B12 in folatov, za izključitev sočasnega pomanjkanja vitamina B12 pri nizki koncentraciji folatov in vitamina B12 v serumu, in pri stanjih, ki lažno spremenija koncentracijo vitamina B12 ali folatov. V zadnji skupini preiskav najpogosteje uporabljamo test absorpcije vitamina B12 (Schillingov test). Z njim potrdimo perniciozno anemijo.
Deskriptorji		ANEMIA, MEGALOBLASTIC VITAMIN B 12 DEFICIENCY FOLIC ACID DEFICIENCY FOLIC ACID HOMOCYSTEINE METHYLMALONIC ACID