Vitamin B12 and folate deficiencies are often difficult to distinguish from one another. Describe the interdependence of these two nutrients and how the deficiency of one may be related to the deficiency of the other.

Vitamin B12 and folate deficiencies are often difficult to distinguish from one another. Describe the interdependence of these two nutrients and how the deficiency of one may be related to the deficiency of the other.

The following 4 books are resources for more in-depth studying:
?    Edelstein S and Sharlin J: Life Cycle Nutrition: An Evidence Based Approach. Jones and Bartlett 2009. ISBN 13: 978-0-7673-3810-5 (assigned chapters are included in the required textbook)
?    Samour P Q, King K: Pediatric Nutrition, 4th ed., Jones and Bartlett, 2012. ISBN-13: 978-0-7637-8450-8 (assigned chapters are included in the required textbook)
?    Chernoff R. et al.: Geriatric Nutrition: The Health Professional’s Handbook. Jones and Bartlett, 3rd ed., 2006. ISBN-13: 978-0-7637-3181-6 (assigned chapters are included in the required textbook)
?    McArdle WD, Katch FI, Katch VL: Sports and Exercise Nutrition, Wolters Kluwer, 4th ed., 2013. ISBN-13 978-1-4511-1806-3

Case study Anemia in Pregnancy
Note: This case study is based on cases in the Nelms books in combination with a review of current literature to generate an original case study. Cases of iron deficiency anemia and folate deficiency anemia occur more frequently, thus their treatment challenges are included here.

Patient summary: A.B.C. is a 21 year-old white female, 5 months pregnant, admitted through the ER after falling and possible syncope to rule out premature labor. Her CBC warranted a complete hematologic work-up.

Pt Summary: 21yo wf, gravida 1, para 0, presented 23rd week of gestation, after a fall with vaginal spotting and abdominal pain. Admitted to r/o premature labor secondary to the fall. Patient c/o fatigue.

History: ABC is a 21 year-old pregnant woman, gravida 1, para 0, who presented to the ER in her 23rd week of gestation. She has experienced vaginal spotting and some abdominal pain. She reports being very tired and sometimes being unusually short of breath.
Medical history: not contributory
Surgical history: none
medications at home: prenatal vitamins – pt reports not using the prescription
Tobacco use: none
alcohol use: about 1 glass of wine per month, socially
family history: Mother: pernicious anemia, colon cancer; Father: HTN, CAD s/p MI

Demographics:
Married, lives with husband, 2 years of college, full-time position as office clerk; ethnicity: Caucasian, no religious affiliation

Admitting Hx/PE
CC: “I was shopping at the mall when I passed out and fell while looking at some clothes. After I got back home I noticed a small amount of bleeding when I went to the bathroom. Over the next hour, I had some abdominal pain. I called my doctor and the office said I should come here to be checked out.”
General appearance: 21-year-old pregnant female, pale, in no acute distress.

Vital Signs: Temp: 98.6, Pulse: 88, RR: 19, BP: 118/72, height: 5’5”, weight: 128#, prepregnancy weight: 118#

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