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Blood, 15 September 2008, Vol. 112, No. 6, pp. 2214-2221. Prepublished online as a Blood First Edition Paper on July 7, 2008; DOI 10.1182/blood-2008-03-040253. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2008-03-040253v1 112/6/2214    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Carmel, R. PubMed PubMed Citation Articles by Carmel, R. Related Collections Red Cells How I Treat Free Research Articles Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  HOW I TREAT How I treat cobalamin (vitamin B12) deficiency Ralph Carmel1 1 Department of Medicine, New York Methodist Hospital, Brooklyn, and Weill Medical College, Cornell University, New York, NY The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor–driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose. The virtues of these principles are not always fully appreciated. Recent developments have made diagnosis and management more difficult by diminishing the ability to determine cobalamin absorption status. Clinicians must also grapple with premature medicalization of isolated, mild biochemical changes that added many asymptomatic cases of still undetermined medical relevance to their caseload, often expanded by inflated cobalamin level criteria. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. Pathophysiologically based management requires systematic attention to each of its individual components: correctly diagnosing cobalamin deficiency, reversing it, defining its underlying cause, preventing relapse, managing the underlying disorder and its complications, and educating the patient. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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