E. Vitamin B12 deficiency – Explanation
High MCV and low Hb – Macrocytic anaemia
These findings together with a history of ileal resection whereby malabsorption of B12
could occur, points towards the diagnosis of B12 deficiency.
COMPARISON OF CAUSES BETWEEN VITAMIN B12 AND FOLATE DEFICIENCY
| Cause | Vitamin B12 deficiency | Folate deficiency |
| Malabsorption | Pernicious anaemia | Poor bioavailability |
| Medical conditions |
Inflammation of small intestine (coeliac disease, tropical sprue, Crohn’s disease) Gastric resection (for reasons of obesity or cancer) |
Inflammation of small intestine (coeliac disease, tropical sprue, Crohn disease |
| Inadequate dietary intake |
Low intake of cobalamin rich foods |
Low intake of folate rich foods (usually vegetables) |
In PLAB, one distinction that may help you choose between B12 and folate deficiency is
the diet. Good food sources of folate include broccoli, brussels sprouts, asparagus,
peas (basically vegetables). Thus if the given scenario is a vegetarian, it is unlikely that
he is suffering from folate deficiency. In that case, pick B12 deficiency.
