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<Provider Id="sundheddkcms"> <Item Id="{607B515C-63D6-4C24-8360-9169CD92CE8E}" Name="vitamin-b12-mangel" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{679CED2A-382C-4F25-9AEF-CC1C7340FC92}" SortOrder="1100" PublishDate="2010-08-06T14:24:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Resumé</h2> <table style="height: 96px; width: 630px;"> <tbody> <tr> <td style="background-color: #dbe5f1; text-align: left;"> <p><strong>Diagnose</strong></p> <ul> <li>Stilles ved påvisning af makrocytær anæmi med forhøjet MCV (>100 fl) og nedsat Vitamin B12</li> <li>Diagnosen kan ved tvivlstilfælde bekræftes ved måling af methylmalonat, som er forhøjet </li> <li>Der kan påvises makroovalocytter (store ovale erytrocytter) og hypersegmenterede granulocytter (mere end 5 kernelapper) i perifert blodudstryg</li> <li>Homocystein er også forhøjet, men mindre specifik (også forhøjet ved folatmangel, samt ved nyreinsufficiens)</li> </ul> <p><strong>Behandling</strong></p> <ul> <li>Behandling med Vitamin B12. Behandlingen gives enten som injektionsbehandling eller peroralt</li> </ul> <p><strong>Henvisning</strong></p> <ul> <li>Patienten bør henvises til gastromedicinsk udredning, såfremt der ikke er åbenlys mangel på indtagelse som forklarer tilstanden </li> <strong></strong> </ul> </td> </tr> </tbody> </table> <h2>Diagnose</h2> <h3>Sygehistorie</h3> <h4>Perniciøs anæmi</h4> <ul> <li>Patienter med denne relativt sjældne, klassiske sygdom har symptomer på makrocytær anæmi, glossitis og eventuelt neurologiske manifestationer som neuropati med paræstesier og unormal gang på grund af forstyrrelser i vibrationssans og proprioception</li> <li>De fleste af disse patienter er lette at diagnosticere. Hvis de bliver diagnosticeret og behandlet i tide, kan de blive helbredt, men neuropatien kan i sværere tilfælde være irreversibel</li> </ul> <h4>Centrale anamnestiske oplysninger</h4> <ul> <li>Vegetar/veganer?</li> <li>Tarmsygdom?</li> <li>Fjernet noget af mavesækken eller tarmen?</li> <li>Anden autoimmun lidelse (type I diabetes, Mb. Graves, vitiligo)?</li> <li>Hos børn bør genetiske defekter overvejes såfremt der påvises B12 mangel</li> </ul> <h3>Kliniske fund</h3> <ul> <li>Neurologiske udfald?</li> <li>Psykiatriske symptomer?</li> <li>Anden autoimmun lidelse (vitiligo)?</li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <h4>Blodprøver</h4> <ul> <li><strong></strong>Hb, MCV, MCHC, retikulocyttal, plasma cobalamin, serum folat, leukocyt- og differentialtælling, trombocyttal, ALAT, LDH, basisk phosphatase, bilirubin, koagulationsfaktorer 2,7,10, albumin, kreatinin, Na+, K+, CRP</li> </ul> <h4>Tolkning </h4> <ul> <li>Ved B12 mangel er anæmien typisk megaloblastær, dvs. makrocytær (forhøjet MCV)</li> <li>LDH ofte forhøjet - afspejler hæmolyse (karakteristisk er hæmolysen ikke - som normalt ved hæmolytiske anæmier - ledsaget af retikulocytose, da erytropoiesen mangler byggestenen vitamin B12 for at kunne generere erytrocytter). LDH-værdier op til flere 1000 ikke ualmindeligt</li> <li>Anæmien kan være meget udtalt på diagnosetidspunktet og desuagtet forbavsende få anæmisymptomer. Patientens kardiovaskulære system har adapteret sig til den lave Hb-koncentration - anæmien er udviklet langsomt over mange måneder</li> <li>Eventuelt ses samtidig leukopeni og trombocytopeni (= pancytopeni), idet vitamin B12-manglen involverer alle 3 cellelinjer</li> <li>De to metabolitmarkører methylmalonat (MMA) og homocystein betragtes som mere sensitive markører på vitamin B12 status end plasma cobalaminværdierne</li> <li>Plasma cobalamin <ul> <li>Er rutineundersøgelsen og er nedsat ved vitamin B12-mangel</li> <li>Testen er let tilgængelig og billig. Referenceværdierne varierer, fordi forskellige metoder anvendes</li> <li>Plasma cobalamin kan være nedsat, hvis haptocorrin er reduceret (granulocytopeni), og øget, hvis haptocorrin er øget (granulocytose) (f.eks. ved de kroniske myeloproliferative sygdomme - især ved polycythæmia vera, primær myelofibrose og kronisk myeloid leukæmi)</li> <li>Patienter med leukopeni kan således have lave B12 niveauer uden at have klinisk B12 mangel. Her bruges MMA til at skelne mellem reel og pseudo B12 mangel</li> </ul> </li> <li>Metylmalonat (MMA) <ul> <li>Øget ved vitamin B12-mangel</li> <li>Testen er ikke en rutineanalyse, og den er kostbar</li> <li>Sensitiviteten er høj, men specificiteten er diskutabel</li> <li>Falsk positive værdier ses hyppigt ved nedsat nyrefunktion</li> </ul> </li> <li>Total homocystein <ul> <li>Øget ved vitamin B12-mangel</li> <li>Sensitiviteten er høj, mens specificiteten er lav. Påvirkes af livsstilsfaktorer som rygning, alkoholindtagelse, kaffeforbrug</li> <li>Homocystein er også forhøjet ved folatmangel, ved vitamin B6-mangel og ved reduceret nyrefunktion</li> </ul> </li> </ul> <h4>Trin 1 </h4> <ul> <li>Cobalamin anbefales som første prøve (med forbehold for variationer i referenceområdet)</li> <li>Hvis værdien er over 250 pmol/l, foreligger der ikke vitamin B12-mangel</li> <li>Hvis prøvesvaret er 25 % lavere end nedre grænse i referenceområdet, foreligger der B12-mangel (<125 pmol/l hvis nedre grænse er 156 pmol/l)</li> <li>Hvis prøvesvaret er 125-250 pmol/l, anbefales at tage MMA <ul> <li>Baseret på MMA-værdien og kliniske tegn, kan vitamin B12-mangel bekræftes (MMA > 0,75 µmol/l) eller afvises (MMA < 0,29 µmol/l)</li> <li>Hvis MMA er i området 0,29-0,75 µmol/l anbefales ny prøve af cobalamin og MMA efter et år, med mindre der er klare kliniske tegn på vitamin B12-mangel og behov for behandling <ul> <li>moderat øget MMA stiger ikke væsentligt på 1-4 år uden behandling</li> </ul> </li> </ul> </li> <li>Moderat forhøjede MMA-værdier har i behandlingsstudier vist sig at give mindre klinisk effekt af behandling med vitamin B12, derfor anbefales grænsen at ligge så højt som > 0,75 µmol/l</li> <li>Når diagnosen vitamin B12-mangel er stillet, er næste udfordring at finde årsagen</li> </ul> <h4>Trin 2 </h4> <ul> <li>Ved kostsvigt (vegetar eller veganer) eller hos patienter med ventrikel- eller ilealresektion er yderligere laboratorieprøver sædvanligvis unødvendige</li> <li>Hos alle andre patienter anbefales yderligere tests for at klargøre årsagen til vitamin B12-manglen og særligt for at afklare, om patienten har klassisk perniciøs anæmi</li> </ul> <h4>Trin 3 </h4> <ul> <li>Antistoffer mod intrinsic factor <ul> <li>Er patognomonisk for perniciøs anæmi</li> <li>Specificiteten er ca. 100 %, mens sensitiviteten er ca. 70 %</li> </ul> </li> <li>Parietalcelle antistoffer <ul> <li>Påviselig hos ca. 80 % med perniciøs anæmi</li> <li>Specificiteten er meget lav</li> </ul> </li> </ul> <h4>Udredning af vitamin B12 mangel</h4> <p><img alt="Figur der viser udredning af vitamin B12 mangel" title="Udredning af vitamin B12 mangel" src="2B89B74F5896403B84A6DB14D4C35B0A-239-157" style="height: 157px; width: 239px;" height="157" width="239"></p> <h3>Andre undersøgelser hos specialist eller på sygehus</h3> <ul> <li>Endoskopi? <ul> <li>Da patienter med perniciøs anæmi har øget risiko for at udvikle ventrikelkræft. Kontrolgastroskopi med regelmæssige mellemrum anbefales ikke generelt, men bør foretages ved mindste mistanke om udvikling af ventrikelcancer (dyspepsi, vægttab, jernmangelanæmi)</li> </ul> </li> <li>Knoglemarvsundersøgelse?? <ul> <li>Er ikke længere standardundersøgelse ved vitamin B12-mangel</li> <li>Bør kun foretages hvis der er mistanke om samtidig malignitet, eller hvis diagnosen er usikker</li> </ul> </li> </ul> <h3>Diagnostiske kriterier</h3> <ul> <li>Lavt plasma cobalamin og/eller højt metylmalonat og total homocystein</li> <li>Evt. kliniske tegn på perniciøs anæmi</li> <li>Se detaljer under supplerende undersøgelser</li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li><a href="~/link.aspx?_id=D034F70CE577455C82B08497E96CFB0A&_z=z">Folatmangel</a></li> </ul> <h3>Hvornår bør vitamin B12-mangel mistænkes?</h3> <ul> <li>Tilstanden bør mistænkes hos alle patienter med makrocytær anæmi</li> <li>Tilstanden bør mistænkes hos alle patienter med uforklarlige neuropsykiatriske symptomer og/eller gastrointestinale symptomer som f.eks. anoreksi og diarré</li> <li>Speciel opmærksomhed bør vies patienter, som er i risiko for at udvikle vitamin B12-mangel <ul> <li>Ældre mennesker med øget risiko for atrofisk gastritis</li> <li>Vegetarer og veganere</li> <li>Patienter med intestinal sygdom</li> </ul> </li> <li>Andre grupper i risiko er patienter med autoimmune sygdomme som Graves' sygdom, thyreoiditis og vitiligo, og patienter som anvender protonpumpehæmmere, H2-blokkere eller metformin i lange perioder</li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Korrigere vitamin B12 niveauet i kroppen</li> <li>Forhindre udvikling af perniciøs anæmi</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Det er ikke altid let at fastslå, om en patient lider af vitamin B12-mangel, idet specificiteten af p-cobalamin ikke er høj, og der findes ikke sjældent moderat nedsatte værdier, selvom patienten har vitamin B12 mangel, dvs. falsk positive</li> <li>Patienter med vitamin B12-mangel som har normal absorption, så som vegetarer og veganere, behøver kun dagligt tilskud i form af en vitaminpille som indeholder mindst 6 µg af vitamin B12</li> <li>Patienter med irreversible årsager til vitamin B12-mangel behøver livslang behandling med farmakologiske doser af vitamin B, f.eks. intramuskulær injektion af [DliActiveSubstance;6327;hydroxocobalamin] 1 mg. hver anden dag til i alt 5 gange, herefter livslangt hver 3. måned. Alternativt kan behandles med [DliActiveSubstance;6039;cyanocobalacin] peroralt 1 mg. dagligt. Injektionsbehandling kan normalt reserveres til indledende behandling af patienter som har akutte neurologiske manifestationer, samt til patienter som har fået reseceret terminale ileum. Øvrige patienter kan behandles med peroral behandling </li> </ul> <h3>Håndtering i almen praksis </h3> <ul> <li>Injektionsbehandling alternativt ordination af peroralt tilskud</li> <li>Opfølgende kontrol af b12 eller MMA afhængigt af niveauer og om der er indledt behandling (se algoritmen ovenfor)</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Vegetarer og veganere <ul> <li>Det er beregnet, at tre deciliter mælk og tre osteskiver om dagen dækker dagsbehovet for vitamin B12</li> <li>Såfremt kosten ikke indeholder animalske produkter overhovedet, bør behovet dækkes med tilskud af vitaminpille (som indeholder minimum 6 mikrogram B12 vitamin)</li> </ul> </li> </ul> <h3>Medicinsk behandling</h3> <ul> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/71010">Vitamin B12</a> <ul> <li>Forskellige former for vitamin B12 kan bruges, inklusive hydroxy-, cyano- og methylcobalamin</li> <li>[DliActiveSubstance;6327;Hydroxycobalamin] har fordelen med en langsom metabolisme, dog har depotvarianten af [DliActiveSubstance;6039;cyanocobalamin] endnu langsommere metabolisme</li> </ul> </li> <li>Administrationsform <ul> <li>Injektion <ul> <li>I de fleste lande gives vitamin B12 fortsat som intramuskulære injektioner i form af [DliActiveSubstance;6327;hydroxycobalamin]</li> <li>Tradition vedrørende både dosis og administrationsform varierer betydeligt</li> <li>I Danmark er anbefalet praksis at injicere 1000 µg af depotpræparatet af hydroxycobalamin hver 2. dag til i alt 5 gange og derefter hver 3. måned</li> <li>Af en eller anden ukendt grund er der nogle patienter, som behøver vedligeholdelsesbehandling med kortere intervaller</li> </ul> </li> <li>Tabletter <ul> <li>Nogle foretrækker at bruge peroralt vitamin B12</li> <li>Flere studier rapporterer, at en daglig dosis med mindst 1000 µg [DliActiveSubstance;6039;cyanocobalamin] er tilstrækkelig til at opretholde normal vitamin B12 status hos patienter med hæmatologiske manifestationer</li> <li>Effekten af peroral behandling hos patienter med markante neurologiske manifestationer er ikke tilstrækkeligt afklaret, således at for denne gruppe vil man indtil videre anbefale parenteral behandling indledningsvist</li> </ul> </li> </ul> </li> <li>Hos patienter med anæmi <ul> <li>Når behandlingen med vitamin B12 er startet, vil den øgede produktion af røde blodceller (retikulocytose) øge jernbehovet. Derfor er det vigtigt at monitorere og korrigere jernmangel hos patienter med ferritin lavt i normalområdet</li> <li>Folatmangel kan afdækkes gennem et fald i plasma folat efter opstart med vitamin B12 behandling</li> </ul> </li> </ul> <h3>Anden behandling</h3> <h3>Behandling ved uklart sygdomsbillede</h3> <ul> <li>Det er vanskeligt at give råd om behandling eller ikke hos patienter, hvor kliniske symptomer og laboratorieprøver er modstridende</li> <li>Hos patienter med klare tegn på vitamin B12-mangel anbefales behandling uafhængigt af, hvad laboratorieprøverne måtte vise</li> <li>Hos patienter med uspecifikke symptomer i kombination med prøvesvar som ligger i grænseområdet kan man vurdere at følge effekten af vitamin B12 behandling og fortsætte behandlingen, hvis der tilkommer klar klinisk bedring, evt. tage nye prøver efter 1 år</li> </ul> <h3>Forebyggende behandling </h3> <ul> <li>Tilstrækkeligt indtag via kosten </li> <li>Patienter med malabsorptionstilstande eller kirurgi på ventrikel eller tyndtarm (f.eks. gastric bypass operation eller ileocøkal resektion) bør gives tilskud for at forebygge udvikling af B12 mangel. Injektionsbehandling kan være nødvendig ved ileocøkal resektion</li> </ul> <h3>Henvisning</h3> <ul> <li>Ved usikkerhed om diagnosen og ved manglende respons på behandling</li> </ul> <h2>Opfølgning </h2> <ul> <li>Blodprøvetagning for at følge op på anæmien, og at denne reverseres (se også nedenfor under monitorering af behandlingseffekt)</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Forløbet er uklart, men man antager, at for mange vil tilstanden progrediere uden behandling</li> </ul> <h3>Komplikationer</h3> <ul> <li>Perniciøs anæmi</li> </ul> <h3>Prognose</h3> <ul> <li>God med tidlig behandling og før irreversible neurologiske skader foreligger</li> </ul> <h2>Monitorering af behandlingseffekt </h2> <ul> <li>Vedr. anæmi er monitoreringen simpel - måling af Hb-koncentrationen (f.eks. efter ca. 1 mdr.) og hertil kan føjes måling af retikulocyttallet (f.eks. efter 1 uge) som prompte vil stige i løbet af dage, når behandling med vitaimin B12 indledes</li> <li>Vedr. andet klinisk billede - f.eks. polyneuropati - er det en klinisk vurdering der afgør, om der er behandlingseffekt</li> <li>Vedr. biokemisk monitorering af behandlingen hos patienter som ikke har anæmi (jvf. ovenfor): Måling af plasma cobalamin. Hvis den er normal (eller forhøjet) under behandling, får patienten sufficient behandling</li> <li>Vedr. [DliActiveSubstance;6327;injektionsbehandling] versus [DliActiveSubstance;6039;tabletbehandling]: Overordnet ligeværdige. Hvis tabletbehandling vælges, anbefales at måle plasma-cobalamin 1-2 gange årligt (dårlig compliance ?) </li> </ul> <h2>Baggrundsoplysninger<a title="Lindenbaum J, Healton EB, Savage DG, Brust JC, Garrett TJ, Podell ER, et al, Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318: 1720-8" href=" " data-type="journal-reference" data-value-piped="Lindenbaum J, Healton EB, Savage DG, Brust JC, Garrett TJ, Podell ER, et al|Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis|N Engl J Med|1988|318|1720-8" data-value="Lindenbaum J, Healton EB, Savage DG, Brust JC, Garrett TJ, Podell ER, et al, Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318: 1720-8" data-url="reference-link">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J, Effective treatment of cobalamin deficiency with oral cobalamin.. Blood 1998;92: 1191-8" data-value-piped="Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J|Effective treatment of cobalamin deficiency with oral cobalamin.|Blood|1998|92|1191-8|9694707" data-url="reference-link" data-pubmedid="9694707" title="Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J, Effective treatment of cobalamin deficiency with oral cobalamin.. Blood 1998;92: 1191-8">2</a><sup>,</sup><a title="Birgens HS , Bergmann O, Borregaard N et al, Benigne hæmatologiske sygdomme hos voksne. Diagnostik og behandling. Ugeskrift for Læger 2003;4: 22" href=" " data-type="journal-reference" data-value-piped="Birgens HS , Bergmann O, Borregaard N et al|Benigne hæmatologiske sygdomme hos voksne. Diagnostik og behandling|Ugeskrift for Læger|2003|4|22" data-value="Birgens HS , Bergmann O, Borregaard N et al, Benigne hæmatologiske sygdomme hos voksne. Diagnostik og behandling. Ugeskrift for Læger 2003;4: 22" data-url="reference-link">3</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Hvas AM, Ellegaard J, Nexø E, [Diagnosis of vitamin B12 deficiency--time for reflection].. Ugeskr Laeger 2003;165: 1971-6" data-value-piped="Hvas AM, Ellegaard J, Nexø E|[Diagnosis of vitamin B12 deficiency--time for reflection].|Ugeskr Laeger|2003|165|1971-6|12795070" data-url="reference-link" data-pubmedid="12795070" title="Hvas AM, Ellegaard J, Nexø E, [Diagnosis of vitamin B12 deficiency--time for reflection].. Ugeskr Laeger 2003;165: 1971-6">4</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Norberg B, [Vitamin B12 in the Nordic countries. Deficiency, diagnosis, treatment in Sweden].. Ugeskr Laeger 2003;165: 1977-9" data-value-piped="Norberg B|[Vitamin B12 in the Nordic countries. Deficiency, diagnosis, treatment in Sweden].|Ugeskr Laeger|2003|165|1977-9|12795071" data-url="reference-link" data-pubmedid="12795071" title="Norberg B, [Vitamin B12 in the Nordic countries. Deficiency, diagnosis, treatment in Sweden].. Ugeskr Laeger 2003;165: 1977-9">5</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Solomon LR, Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing.. Blood 2005;105: 978-85; author reply 1137" data-value-piped="Solomon LR|Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing.|Blood|2005|105|978-85; author reply 1137|15466926" data-url="reference-link" data-pubmedid="15466926" title="Solomon LR, Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing.. Blood 2005;105: 978-85; author reply 1137">6</a>,<a title="Vidal-Alaball J, Butler CC, Cannings-John R, Goringe A, Hood K, McCaddon A, et al. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev 2005" href="http://www.cochrane.org/CD004655/ENDOC_oral-vitamin-b12-versus-intramuscular-vitamin-b12-for-vitamin-b12-deficiency" data-type="other-reference" data-value="Vidal-Alaball J, Butler CC, Cannings-John R, Goringe A, Hood K, McCaddon A, et al. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev 2005" data-url="http://www.cochrane.org/CD004655/ENDOC_oral-vitamin-b12-versus-intramuscular-vitamin-b12-for-vitamin-b12-deficiency">7</a><sup>,</sup><a title="Hvas A-M, Nexo E, Diagnosis and treatment of vitamin B12 deficiency. An update. Haematologica 2006;91: 1506-12" href=" " data-type="journal-reference" data-value-piped="Hvas A-M, Nexo E|Diagnosis and treatment of vitamin B12 deficiency. An update|Haematologica|2006|91|1506-12" data-value="Hvas A-M, Nexo E, Diagnosis and treatment of vitamin B12 deficiency. An update. Haematologica 2006;91: 1506-12" data-url="reference-link">8</a><sup>,</sup><a title="Stabler SP, Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013;368(2): 149-60" href=" " data-type="journal-reference" data-value-piped="Stabler SP|Clinical practice. Vitamin B12 deficiency|N Engl J Med|2013|368(2)|149-60" data-value="Stabler SP, Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013;368(2): 149-60" data-url="reference-link">9</a><sup>,</sup><a title="Sundhedsstyrelsen: Rationel Farmakoterapi: Midler mod Blodmangel" href="https://www.sst.dk/da/viden/laegemidler/anbefalinger/den-nationale-rekommandationsliste-_nrl_/aeldre-rekommandationer/midler-mod-blodmangel" data-type="other-reference" data-value="Sundhedsstyrelsen: Rationel Farmakoterapi: Midler mod Blodmangel" data-url="https://www.sst.dk/da/viden/laegemidler/anbefalinger/den-nationale-rekommandationsliste-_nrl_/aeldre-rekommandationer/midler-mod-blodmangel">10</a><sup>,</sup><a title="Vitamin B12-mangel uden anæmi – en vigtig diagnose af Ebba Nexø, Bettina Borre Buhl, Johan Frederik Håkonsen Arend, Månedskrift for almen praksis, 2017" href="https://www.maanedsskriftet.dk/files/pdf/11914.pdf" data-type="other-reference" data-value="Vitamin B12-mangel uden anæmi – en vigtig diagnose af Ebba Nexø, Bettina Borre Buhl, Johan Frederik Håkonsen Arend, Månedskrift for almen praksis, 2017" data-url="https://www.maanedsskriftet.dk/files/pdf/11914.pdf">11</a></h2> <h3>Definition</h3> <ul> <li>Nogle patienter med vitamin B12 (cobalamin) mangel vil med tiden udvikle klassisk perniciøs anæmi, som sædvanligvis er nem at diagnosticere </li> <li>Den diagnostiske udfordring gælder patienter, som har vitamin B12-mangel, ofte uden anæmi </li> <li>Selv om det er vanskeligt at diagnosticere asymptomatiske patienter, er det vigtigt at stille diagnosen tidligt, fordi eventuelle neurologiske manifestationer kan blive irreversible, hvis behandlingen sættes ind for sent </li> <li>Man har ledt efter tidlige biokemiske markører for vitamin B12-mangel og har forbedret metoderne for måling af de to metabolitter, som akkumuleres, hvis vitamin B12 mangler: <ul> <li>Plasma metylmalonat (MMA) </li> <li>Plasma total homocystein (tHcy)</li> </ul> </li> </ul> <h3>Forekomst</h3> <ul> <li>Hvis vitamin B12-mangel defineres som en øget koncentration af MMA, er vitamin B12-mangel ikke længere nogen helt sjælden sygdom, dog er der en del fejlkilder forbundet med MMA (kan også blive forhøjet ved nyreinsufficiens)</li> </ul> <h4> Ætiologi og patogenese</h4> <p> </p> <ul> <li>Mangel på vitamin B12 kan skyldes utilstrækkelig indtagelse eller malabsorption af vitamin B12</li> </ul> <h4>Utilstrækkelig indtagelse</h4> <ul> <li>Ses blandt vegetarer som helt afholder sig fra animalske produkter (oftest veganere som heller ikke indtager æg eller mejeriprodukter)</li> <li>Bortset herfra er utilstrækkeligt indtagelse usædvanlig i den industrialiserede del af verden</li> </ul> <h4>Malabsorption</h4> <ul> <li>Malabsorption af vitamin B12 forekommer hos patienter med forskellige gastrointestinale sygdomme </li> <li>Nedsat eller ophævet udskillelse af gastrisk intrinsic factor og/eller hypo- eller aklorhydri som ses hos patienter med ødelagt ventrikelslimhinde, forårsaget enten af autoimmune mekanismer med antistoffer mod parietalceller eller som følge af slimhindeatrofi</li> <li>Aklorhydri, f.eks. ved længerevarende protonpumpehæmmerbehandling, nedsætter spaltning af vitamin B12 fra protein i kosten, og da intrinsic factor er nødvendig for den intestinale internalisering af vitamin B12, kan mangel på dette protein føre til forstyrret vitamin B12 optagelse </li> <li>Prævalens af ventrikelatrofi stiger med alderen - måske en forklaring på, at malabsorption af vitamin B12 bliver hyppigere med alderen </li> <li>Malabsorption forekommer også ved pankreassvigt på grund af mangel på de enzymer, som behøves for at frigøre vitamin B12 fra det protein (haptocorrin) som binder det fordøjede vitamin B12 </li> <li>Andre årsager til malabsorption er ventrikel- eller ileum-resektion og forstyrrelser i tyndtarmen som f.eks. cøliaki, Crohns sygdom og ileitis </li> <li>Langtidsbrug af protonpumpehæmmere, H2-receptor blokkere og biguanider (metformin) kan føre til nedsat optagelse af vitamin B12 og muligvis udvikling af vitamin B12-mangel</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Vegetarer/veganere</li> <li>Spædbørn af veganere/vegetarer, som ikke får tilført vitamin B12 via modermælken grundet mangel hos moderen </li> <li>Ventrikel- eller ileum-resektion </li> <li>Gastrointestinale sygdomme med kompromitteret absorption af vitamin B12 (f.eks. cøliaki, Mb. Crohn) </li> <li>Visse medikamenter (se ovenfor)</li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>DD510-519</p> <h2>Patientinformation</h2> <h3>Link til patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=EA02B64EC97D4F7EB473E6C631BAD68F&_z=z">Vitamin B12-mangel</a></li> </ul> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og regionale pakkeforløb [ICPC]</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">25886</TextField> <TextField Name="PageTitle">Vitamin B12 mangel</TextField> <TextField Name="NavigationTitle">Vitamin B12 mangel</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2022-01-03T14:56:00</DateTimeField> <LinkListField Name="Authors"> <LinkField linktype="internal">{3F7E8AE9-7C01-42F5-94B0-FD46B72E9547}</LinkField> <LinkField linktype="internal">{38A2EF96-CA6D-4047-AB47-529CC80F5EA6}</LinkField> <LinkField linktype="internal">{03F5C871-573B-4947-B200-B10053FA36F0}</LinkField> <LinkField linktype="internal">{ED7CEC94-3F7A-4FB5-BBB0-A3681BCFC481}</LinkField> </LinkListField> <LinkListField Name="Organization"> <LinkField linktype="internal">{CF77E8B9-9937-42B2-85DF-76B0F4E401F0}</LinkField> </LinkListField> <TextField Name="ICD10">D51, D51.0, D51.1, D51.2, D51.3, D51.8, D51.9</TextField> <TextField Name="ICPC2">B81</TextField> <LinkListField Name="SearchAreaID"> <LinkField linktype="internal">2</LinkField> </LinkListField> <TextField Name="Description">Diagnosen vitamin B12 mangel stilles ved påvisning af makrocytær anæmi med forhøjet MCV (>100 fl) og nedsat vitamin B12. 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