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10 (2) Management Therapy of Folic Acid and B12 Anemia (VERSI LAMA)
10 (2) Management Therapy of Folic Acid and B12 Anemia (VERSI LAMA)
Anemia
Etiologi
anemia
irreversible
neurological disorders.
folate assay
Red cell folate assay
Serum B12 assay
PERAN Folate/B12
Folate
Folic acid
deficiency
use
drug
ABSORPTION
Natural
DISTRIBUTION
Tetrahydrofolate
Ekskresi :
Lebih
CURRENT RECOMMENDED
INTAKE OF FOLATE
Adults
Biochemical functions
one carbon fragment transfer (formyl,
methyl, hydroxymethyl)
conversion
of homocysteine to methionine
conversion of serine to glycine
synthesis of thymidylic acid
synthesis of purines
histdine metabolism
synthesis of glycine
FOLATE DEFICIENCY
Megaloblastic anemia
Neural tube defects
Elevated blood
homocysteine
ANEMIA
Oral administration
of Ac. folicum 1 mg per
day, for 3 months, and maintance therapy if
its necessary.
Bentuk sedian
Tablet 0.4 mg, Tablet 0.8 mg, Tablet 1 mg,
Injeksi 5 mg/ml
Dosis terapi pada penderita anemia
megaloblastik adalah 25O-4O00 g/hari.
Terapi dikatakan berhasil bila kadar
hemoglobin mulai meningkat pada minggu
pertama, dan sembuh dalam 12 bulan
Kontra indiasi
Penderita
Vitamin B12
Vitamin B12
cyanocobalamin
hydroxocobalamin
function
deficiency
hematological
sequelae
neurological sequelae
Vitamin B12
the
Vitamin B12
synthesized
by bacteria only
Vitamin B12 is bound to the protein in foods. During
digestion, HCl releases the B12 from the protein.
absorbed only in the presence of the intrinsic
factor (a glycoprotein released by parietal
cells)
transported to tissues via transcobalamin II
present in foods such as liver, fish, eggs, milk
absent in vegetables and fruits
stored in the liver as the coenzyme
Eggs
Meat
Dairy
Products
Vitamin B12(cyanocobalamine)
(digested form)
Hydroxycobalamin
Chlorocobalamin
Methylcobalamin
Adenosylcobalamin
(5-deoxyadenosylcobalamin)
Diet
Gastric
deficiency
Failure
Pernicious
Anemia
Total gastrectomy
Ileal
Failure
Regional
organisms
overgrowth
Diphyllobothrium latum
Probability of symptomatic
deficiency
< 75
high
75 - 150
moderate
150 - 220
low
> 220
rare
megaloblastic anemia
megaloblasts
spinal
swelling,
test
distinguishes
Treatment
Supplements
Oral
pills
Intramuscular
Intranasal
Sublingual
Maintenance dosage
Oral
intramuscular
Ringkasan
VITAMIN B12 AND FOLIC ACIDPHYSIOLOGIC CONSIDERATIONS
Vitamin B12
Sources
Daily require
Body stores
Places of
absorption
meat, fish
Folic acid
Gr
vegetables,
yeast
2-5 ug
50-100 ug
3-5 mg (liver) 10-12mg
(liver)
duodenum
and proxymal
ileum
segment of
small
Men
women
Pregnancy
Folat
400
400
600
B 12
2,4
2,4
2,6
Diagnostics:
Schilling test
Medications:
Vit. B12 parenteral