The terminal ileum was removed from a 50-year-old woman during excision of a tumor. About 3 years later, the patient was admitted to the hospital. She is very pale. Hemoglobin is 9 g/dL, MCV (mean corpuscular volume) has increased to 110 μm3 (110 fL). The provisional diagnosis is a vitamin deficiency. What vitamin is the most likely one causing the symptoms and why?
I think the patient is suffering from a deficiency of folic acid.
-Folic acid is involved in the production of carbon residues which are eventually utilized in DNA synthesis .
-The small intestine which consists of the jejunum and the ileum is the site for absorption of folic acid
-Since the distal part of the ileum was removed,this will cause problems in folic acid absorption hence causing a deficiency
-This causes a problem in the development of red blood cells in the bone marrow leading to production of immature cells in large quantiles which contain abnormal nucleus(megaloblastic anaemia).These cells are large in size(macrocytic) but have low hemoglobin(hypochromic)
-This explains why the patient’s MCV value was higher than the normal range of 78-90um3 and it also explains her paleness as low hemoglobin in her cells
Corrections are welcome
Hi Eximia_dc,
Unfortunately your response wasn’t correct. The absorption of Folic acid occurs in the upper Jejunum of the small intestine which is made up of the Duodenum-Jejunum-iluem.
Nevertheless, I mustn’t fail to acknowledge the importance of folic acid in the maturation of RBC. It plays an important role in the synthesis of DNA. Absence of this vitamin as well as vitamin B12 will eventually give rise to a type of anaemia known as “megaloblastic anemia”.
Thank you
Vitamin B12
This is absorbed at this site (with the aid of intrinsic factor)
Vit12 is a maturation factor of erythropoiesis hence the large RBC with pale colour.
This condition is pernicious anaemia.
Correct 💯
Wonderful Response Dr. Hall
Thank you for attempting today’s review question
Warm regards
Vit B12 is necessary for RBC DNA synthesis so any deficiency will lead to “big for nothing RBC” as my lecturer called it. lol.
Hahahaha!
I would love to meet your lecturer. Nice one
Vitamin B12 or cyanocobalamin is the cause of this abnormal health condition
Reasons because vitamin B12 in conjunction with intrinsic factor are responsible for the maturation of red blood cell. The absorption of the vitamin occur in the lumen of the ileum, so if the ileum is absent, it wont be absorbed and hence deficiency leading to lack of red blood cell maturation.
Also 250 million hb are in each mature red blood cell, so if the red blood cell doesn’t attain full maturity, the normal haemoglobin level won’t be achieved.
An excellent response!
The absorption of Vitamin B12 occurs in the Ileum of the GUT. The presence of intrinsic factor aids the absorption process only. Vitamin B12 in conjunction with Folic acid is responsible for the maturation of RBC ¬ intrinsic factor.
Thank you
Vitamins B12 deficiency.
This is because vitamin B12 is absorbed in the last part of the small ileum (terminal). This will result to hypochromic/nomocromic macrocytic anemian; a type of anaemia in which the cells are bigger than normal. This is because vitamin B12 is an essential factor for the maturation of RBC.
Note; RBC matures by reduction in size, disintegration of the nucleus and formation of haemoglobin.
The absence of B12 will result to buggers cells which will reflect on the MCV.
MCV in simple language Is the volume occupied by a red blood cell (mean corpuscular volume)
Hi Olayinka,
This is truly a remarkable attempt
Great response!
Thank you for attempting today’s review question. Please keep it up.
Warm regards
She suffering from pernicious anaemia which is vitamin B12 deficiency.
vitamin B12 plays an important role in supplying essential methyl groups for protein and DNA synthesis. Deficiency of vitamin 12 leads to enlargement of the RBC and decrease content of haemoglobin (macrocytic hypochromic).
Correct 💯
vitamin B12 Deficiency is termed pernicious anaemia. The term pernicious means “deadly” and this name was ascribed to the condition because it was often fatal to patients who suffered from the condition until the causal agent was identified.
Thank you for attempting today’s review question.
Warm regards
Vitamin B12 (cyanocobalamin)…….because it is produced in the large intestine by the intestinal flora. And its absorption from the intestine requires the presence of Intrinsic factor of castle.
Hi Mmhaliru,
Vitamin B12 is produced by the intestinal Flora of the GUT as well as supplied in diet. The absorption of this essential vitamin is aided by the intrinsic factor of castle and the site of absorption is at the Ileum which is a part of the small intestine and not the large intestine.
Great attempt!
Thank you
It’s most likely vitamin B12. It’s produced by some bacteria in the ileum of humans, coupled with the hemoglobin level, the person is most likely suffering from megaloblastic anemia
Correct 💯
Vitamin B12 is produced by both bacteria Flora of the intestine and via dietary supply.
Wonderful response deymolah!
Thank you for attempting today’s review question
Warm regards