1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. Specific diagnostic test: antibodies IF
2.1.2. Goals
2.1.2.1. regain the normal level of B12
2.1.2.2. restore hemoglubin level
2.1.2.3. reduce symptoms of HF
2.1.2.4. improve the appetite
2.1.2.5. hematopeiosis restoration
2.1.2.6. neurological assesment
2.1.3. hemoglobin level restoration
2.1.3.1. blood transfusion
2.1.3.1.1. isovolumic exchange
2.1.3.1.2. in sever cases
2.1.3.1.3. given with dirutics
2.1.4. B12
2.1.4.1. parentral
2.1.4.1.1. hydroxycobalamin 1 mg daily3 weeks
2.1.4.1.2. inetially 6 tymes
2.1.4.1.3. maintenance for 1000
2.1.4.2. oral
2.1.4.2.1. oral doses will work (1000-2000 mcg daily)
2.1.4.2.2. depends on the patient values
2.1.4.2.3. might be given after the parentral
2.1.5. Folate
2.1.5.1. 1-5 mg daily for 1-4 mo
2.1.6. HF
2.1.6.1. contintuation of ACE-I & Beta blockers
2.1.6.2. dirutics
2.1.7. on going
2.1.7.1. monitoring
2.1.7.1.1. monitor stool for malignancy suspection
2.1.7.1.2. LDH and billirubin
2.1.7.1.3. assest for recurrent salls
2.1.7.1.4. neurological symptoms
2.1.7.2. supplemintatoion
2.1.7.2.1. potassium for hypokalemia
2.1.7.2.2. nutrition
2.1.7.2.3. Vit. D
2.1.7.3. education about diet
2.1.7.3.1. folate consumption
2.1.7.3.2. diatry products
2.1.7.3.3. her family for compliance
2.1.7.4. social workers
2.1.7.4.1. for depression
2.1.7.5. Psychiatry
2.1.8. Outcomes
2.1.8.1. neurological symptoms improved after 6 mo
2.1.8.2. typical symptoms resolved after 2-3 days
2.1.8.3. reticulosytosis will peak in 1 week
2.2. Prevention
2.2.1. compensate for deficiencies in
2.2.1.1. vegetarians
2.2.1.2. pregnant
2.2.1.3. gastoectomy patients
2.2.1.4. Nitric oxide
2.2.2. genetic consultation
2.2.3. folate for premature newborns
2.2.4. education about healthy food
2.2.4.1. covering the vitamin needs