Question

30 years old came with complaints of easy fatigability, exertional dyspnea, and weight loss. She also complains of frequent falls. Physical examination revealed there was a bilateral decrease in vibration sense. Her hemoglobin levels were 8.2g%. She was treated with folate. Her anemia improved but neurological symptoms worsened. Which of the following is the most probable reason for her condition ?

• A. Folate not absorbed
• B. Unmasked pyridoxine deficiency
• C. Deficiency of folate reductase in CNS
• D. Folate therapy caused rapid use of Vit B₁₂ stores aggravating symptoms

Answer 1

The Correct Option is D

The described patient's condition and response to folate treatment indicate an underlying issue related to Vitamin B₁₂ deficiency. This is deduced from her symptoms and the progression post-treatment:

• The patient exhibits anemia, neurological deficits (like decreased vibration sense), and symptoms of Vitamin B₁₂ deficiency (fatigue, dyspnea, weight loss, and falls).
• Folate deficiency can cause megaloblastic anemia but does not cause neurological symptoms, which suggests Vitamin B₁₂ involvement.
• Folate administration can improve hematological features of anemia but does not address neurological symptoms due to Vitamin B₁₂ deficiency.
• Folate supplementation can exacerbate or "unmask" existing neurological symptoms by increasing the demand for Vitamin B₁₂ in the metabolism of folate, resulting in a rapid depletion of the already limited Vitamin B₁₂ stores.

Therefore, the most probable reason why neurological symptoms worsened despite improved anemia is that folate therapy caused rapid use of Vit B₁₂ stores, aggravating symptoms.