Thursday, December 29, 2011

Do Sweat the Small Stuff

A 50 year old patient with hypertension, diabetes, arthritis, and obesity gets the procedure shown above. Six months after the procedure, he is doing well; he no longer needs antihypertensives or insulin; he only takes some metformin and vicodin. The surgeons say he can go back to his regular family doctor so he shows up at your office. His only complaints are a new numbness and tingling at the tips of his fingers and toes. His laboratory studies show a microcytic anemia.

Challenge: What is the cause of these signs and symptoms?

Image is in the public domain.


Jyrvindrial said...

Missing intrinsic factor and therefore low Vitamin B12 (Cobalamine)

jimmy said...

s/p gastric bypass = iron def anemia- due bypass of the small intestines resulting in non absorbion of iron= microcytic anemia or Iron def anemia....resulting in pt. having numbness and tingling at the tips of his fingers and toes.....

webhill said...

B12 deficiency.

Craig Chen said...

yes - you're all right...combination of iron and b12 deficiencies
Do Sweat the Small Stuff

After a Roux-en-Y Gastric Bypass, micronutrient deficiencies are common. Peripheral neuropathy is seen with vitamin B12 deficiency (due to bypassing the majority of the stomach). Anemia is seen with iron deficiency (due to reduced acid and bypassing the duodenum and proximal jejunum).

Sources: UpToDate; Wikipedia.

kaney said...

Pregnant woman lose a lot of iron and folic acid daily to help with her baby growth and development which makes her more likely to suffer from anemia during pregnancy. Read this article to learn the types, causes and treatment of the common types of anemia during pregnancy.

Multigenics Intensive Care Exhilarin