Normal Malabsorption Syndrome

(excretion of B12) or

IF Deficiency (nonexcretion of B12)

Wl tw

IF deficiency Malabsorption Syndrome (excretion of B12 (nonexcretion of B12

with IF added) with IF added)

Figure 6.5 Parts 1 and 2 of the Schilling test. See text for explanation.

dosage, all of the body stores are saturated. If the therapy is successful, the patient's symptoms will begin to diminish, and a rapid reticulocyte response will commence in 2 to 3 days. Maintenance therapy of vitamin B12 will need to be given every 1 to 2 months for life, and the patient should be monitored by hematological assays.

Folic acid deficiency is fairly easy to treat with oral folate at 1 to 5 mg/day for 2 to 3 weeks. Short-term therapy is usually all that is required, and patients are counseled to increase their dietary intake of folic acid. Changes in the peripheral circulation will be noticed fairly quickly as the MCV comes back into the reference range, the anemia is resolved, and some of the clinical symptoms abate. Dual therapy may be started in those individuals who have a combined deficiency; however, the folic acid will resolve the hematological abnormalities long before the neurological abnormalities are resolved.

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