PROPER DIAGNOSIS OF THE DISEASE AND FURTHER TREATMENT OF B12-DEFICIENCY ANEMIA

Аннотация

In 12-deficiency anemia, the syndrome of damage to the nervous system dominates, which naturally forces them to seek help from a neurologist. In these cases, the correct diagnosis of the disease and further treatment depend on the latter, since the hasty administration of vitamin B12 very quickly leads to the disappearance of megaloblasts from the bone marrow, which are a pathognomonic sign of percinous anemia. This makes it difficult to recognize the true nature of neurological disorders. Unfortunately, it should be recognized that to date, the neurological manifestations of B12-deficiency anemia have not been systematized and do not have a clear description. Keywords: vitamin B12, anemia, neurological syndrome, bone marrow. The aim of the study was to study the frequency and nature of neurological manifestations of B12-deficiency anemia. 52 patients were observed, of which 30 (57%) had neurological manifestations of funicular myelosis. Sensitivity disorders, changes in Achilles and knee reflexes, and gait disorders were most often detected. The complete disappearance of neurological manifestations of Vi-deficient anemia is possible only with a mild degree of funicular myelosis. Key words: B12-deficiency anemia, funicular myelosis. Materials and methods: for 7 years, 52 patients with newly diagnosed B12 deficiency anemia (20 men, 32 women, average age - 64.3 years) were examined together with hematologists. The diagnosis was clinically verified and confirmed by a bone marrow punctate examination. It should be specially noted that megaloblasts were found in all patients in the bone marrow punctate. All patients underwent a thorough neurological examination, involving electroencephalography (18 patients), electroneuromyography-graphy magnetic resonance or computed tomography (10), esophagogastroduodenoscopy (29), if necessary. According to the classification of P.M. Alperin and Yu.G. Miterev [1], anemia of mild severity (HH -110-90 g/l) was present in 13 patients, moderate (HH-89-70 g/l) - in 29 and severe anemia (HH - 69 g/l and below) - in 10 patients. It should be noted that among the examined patients there were no strict vegetarians, patients who had undergone gastrectomy, suffering from Crohn's disease, helminthic invasion (diphyllobothriosis), people taking medications for a long time (aminosalicylic acid, neomycin, etc.), as well as those treated with vitamin B12 injections. This made it possible to exclude the symptomatic nature of B12-deficient anemia and its cytologically unconfirmed variants. Results and their discussion. When examining patients, the straw-yellow coloration of the skin and sclera attracted attention (38; 73%). At the same time, the frequency of detection of this symptom clearly increased with increasing severity of anemia. Normal body mass index (18.5-24.9 kg/m2) was found in 29 patients, decreased ( 25.0 kg/m2) in 22 patients. This corresponds to the observations of L.I. Idelson [4] and generally 101 ILM-FAN VA INNOVATSIYA ILMIY-AMALIY KONFERENSIYASI in-academy.uz/index.php/si indicates that exhaustion among patients with B12 deficiency anemia, despite the presence of severe disease, is relatively rare. Changes from the gastrointestinal tract were present in most patients and were quite specific. Thus, complaints of severity or pain in the epigastric region, belching, nausea, decreased appetite as subjective manifestations of atrophic gastritis were present in 37 (71.1%) patients. The latter was confirmed by esophagogastroduodenoscopy and mucosal biopsy. Of particular note is the presence in some patients of glossitis (Gunther's tongue; 19; 36.5%) - a crimson-colored tongue with smoothed papillae ("varnished"). In some patients (8; 15.4%), in addition, there were areas of inflammation with erosions at the tip and edges of the tongue. The spleen was palpated in 13 (25%) patients, and an increase in liver size was observed in 10 (19.2%) patients. On the part of the cardiovascular system, there was an expansion of the boundaries of relative cardiac dullness to the left (by 1-2 cm), a tendency to tachycardia (average heart rate - 79.8 in 1 min) and arterial hypotension (110/70 -100/60 mmHg). Hyperchromic (43; 82.7%), less often normochromic anemia (9; 17.3%), moderate leukopenia and thrombocytopenia were usually detected in the blood of the examined patients. On the part of erythrocytes, anisocytosis, macrocytosis and the presence of nuclear residues (Jolly corpuscles and Kebot rings) were noted. The number of reticulocytes was reduced or normal. Erythrocaryocytes were often detected. Irritation of the red germ was detected in the bone marrow, and megaloblasts, a characteristic sign of percinous anemia, were also detected. Based on the submitted complaints and the results of an objective neurological examination, all patients were divided into 2 groups. Group 1 included 22 (43%) patients who complained of general weakness, shortness of breath during e