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What is In the treatment of undiagnosed megaloblastic anemia, vitamin B12 and folic acid should be given together because: and explain in detail?
Ans. (B) Folic acid alone causes improvement of anemic symptoms but neurological dysfunction continues(Ref: Katzung 10/e p532; KDT 8/e p656)Vitamin B12 is required for conversion of methionine to homocysteine and for formation of succinyl CoA from methylmalonyl CoA.Deficiency of vitamin B12 results in megaloblastic anemia, GI manifestations and neurological abnormalities (due to demyelination).Folic acid alone will correct the symptoms of megaloblastic anemia but it does not prevent neurological abnormalities, which continue to proceed.Neurological abnormalities manifests initially in the form of loss of posterior column sensations (vibration, proprioception etc.), but later on can result in subacute combined degeneration of spinal cord.