Refer to figures 15-5 & 15-10 to answer the following questions. What would be p

Question

Refer to figures 15-5 & 15-10 to answer the following questions. What would be possible diagnoses from the following cobalamin, MMA and Homocysteine, IF antibody and gastrin assay results? Note: pg/mL = ng/L; Reference range for MMA = 0-.4nmol/mL

(A) [cobalamin] = 200 pg/mL; [MMA] = 0.6nmol/mL; [Homocysteine] = elevated

(B) [cobalamin] = 300 pg/mL; [MMA] = 0.2nmol/mL; [Homocysteine] = normal

(C) [cobalamin] = 490 pg/mL; [MMA] = 0.2nmol/mL; [Homocysteine] = elevated

(D) [cobalamin] = 100 pg/mL; [MMA] = 0.55 nmol/mL; [Homocysteine] =elevated; positive test for IF blocking Ab

(E) [cobalamin] = 100 pg/mL; [MMA] = 0.57nmol/mL; [Homocysteine] =elevated; negative test for IF blocking Ab; [Gastrin] = 150 pg/mL

Cobalamin Assay, Serum 400 ng/L ntrinsic factor blocking antibody 150-400 ng/L Negative indeterminate Positive 50.4 nmol/mL Methylmalonic acid 50.4 nmoVmL Result does not imply a Result does not imply Result consistent deficiency of cobalamin cobalamin deficiency. with pernicious at the cellular level. No further testing Gastrin No further testing suggested suggested anemia. S200 pg/mL 200 pg/mL Result does not Result consistent suggest with pernicious pernicious anemia anemia w FIGURE 15-10 Testing algorithm for the diagnosis of pernicious anemia.

Explanation / Answer

A-Vitamin B12 deficiency

D-pernicious anaemia

E-Pernicious anaemia with vit B12 deficiency

C-Folate deficiency

B-Cobalamine deficiency

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