Journal Defisiensi Vitamin B12 (Hematologi)

 TUGAS JURNAL NAMA: Muhammad Fakhmi A. NIM : 2014730060  TUTOR : dr. dr.

Defsiensi Vitamin B12 S!r S!ra" a"# # $a"i $a"i%a %a &7 %ahu %ahu" " m"# "#'u 'uhk hka" a" ("i ("i"# "#k ka%a" a%a" #)a #)a'a 'a (ar*%*hia +a"# m"+aki%ka" di kdua kaki *'ama 1, -u'a" %rakhir. mrik*aa" mrik*aa" /*ik di%muka" #a"##ua" (!*i*i da" ra*a #%ara". Ti"#ka%a" *rum i%ami" 12 ada'ah 20& (# (r mi'i'i%r 1&12 (m!' (r 'i%r (ada ki*ara" 'a-!ra%!rium i"i -rada dia%a* -a%a* -a$ah. 5ma%!kri% ada'ah 42 42  d"# d"#a" a" !'u !'um m *' *' hidu hidu( ( ra%a ra%ar ra% a%a a 86 9. Ti"#k i"#ka% a% a*am a*am *ru *rum m m%h+' m%h+'ma ma'!" '!"i i ada'ah ada'ah 3600 3600 "m!' "m!' (r 'i%r 'i%r '' '' "!rma' "!rma' ;400 ;400 da" %i"# %i"#k ka% *ru *rum m h!m! h!m!*i *i*% *%i i" " 48 481 1 um!' um!' (r (r 'i%r 'i%r ' '' ' "!r "!rma' ma' ;1 ;14 4.. a#aima"a *haru*"+a *haru*"+a (a*i" i"i dia'ua*i '-ih 'a")u% da" di!-a%i< MASALAH KLINIK 

"#akua" da" ("#!-a%a" d/*i"*i i%ami" 12 *a"#a% ("%i"# kar"a mru(aka" ("+-a- rr*i-' k#a#a'a" *um*um %u'a"# da" dmi'i"a*i ("+aki% *i*%m *ara=. >i%ami" 12 !-a'ami" di*i"%*i* !'h mikr!!r#a"i*m mikr!!r#a"i*m da" did%k*i did%k*i %rda(a% di*-a#ia" di*-a#ia" -*ar da'am maka"a" maka"a" dari h$a" !ri#i". "+ra(a" di *a'ura" ("r"aa" %r#a"%u"# (ada =ak% =ak%!r !r i"%r i"%ri" i"*i *ik k +a"# +a"# di*i di*i"% "%* *i* i* !'h !'h *' *' (ari (ari% %a' a' 'am'am-u" u"# # da" da" (ada (ada ?r*(%!r u-am? diu)u"# i'um. ("+-a- (a'i"# *ri"# dari kkura"#a" i%ami" i%ami" 12 ada'ah ada'ah hi'a"#"+a hi'a"#"+a =ak%!r i"%ri"*ik i"%ri"*ik kar"a kar"a au%!imu" au%!imu" #a*%ri%i* #a*%ri%i* a%r!/ a%r!/ da'am da'am *)ar *)arah ah di* di*-u -u%% ?a"m ?a"mia ia (r"i* (r"i*i!* i!*a? a? m*ki m*ki(u" (u" -a"+ak -a"+ak (a*i" da%a"# d"#a" ma"i=*%a*i %ru%ama "ur!'!#i*. PATOFISIOLOGI DEFISIENSI VITAMIN VITAMIN B12

>i%am >i%ami" i" 12 ada'ah ada'ah ki=ak% ki=ak%!r !r +a"# +a"# ha"+a ha"+a mmi' mmi'iki iki 2 "@im "@im +ai%u +ai%u *i"%a* mi%!"i" da" L  M%h+'ma'!"+'  !"@+m A mu%a*. 5u-u"#a" a"%ara =!'a% da" 12 ada' ada'ah ah +a"# +a"# (a'i (a'i"# "# -r( -r(r ra" a" (ada (ada a"m a"mia ia m#a'!-'a*%ik +a"# m"#a'ami d/*i"*i i%ami". Tr)adi"+a #a"##ua" (ada ma%ura*i *i%!('a*ma m"+-a-ka" "u'i m"#a'ami makr!*i%!*i* ima%uri*a*i "u'i da" hi(r*#m"%a*i (ada #ra"u'!*i% di darah (ri=r. 5i(r*'u'ar da" di*('a*ia *um*um %u'a"# da(a% m")adi %a"da 'ukmia aku%. aku%. 5a*i' 5a*i' ri%r ri%r!(! !(!i* i*i* i* +a"# +a"# %idak %idak =k%i =k%i== di* di*-a -a-k -ka" a" !'h !'h hm!'i hm!'i*i* *i* i"%ramdu'ar da" ('(a*a" dhidr!#"a* 'ak%a% iri i"i m"##a m"##am-a m-ark rka" a" a"mia a"mia hm!'i hm!'i%ik %ik mikr mikr!a" !a"#i! #i!(a% (a%ik. ik. G)a'a G)a'a ki'"i* ki'"i* da" (mrik*aa" 'a-!ra%!rium a"mia m#a'!-'a*%ik (ada darah %(iB(ri=r da" *um*um %u'a"#.

>i%ami" 12 -r=u"#*i u"%uk (rkm-a"#a" da" a$a' mi'i"i*a*i (ada *i*%m *ara= (u*a% *(r%i (m'iharaa""+a d"#a" =u"#*i "!rma'. Cmi'i"a*i (ada *rika' da" %!rak* (ada -a#ia" d!r*a' da" 'a%ra' di *(i"a' !rd %rkada"# dmi'i"a*i *ara= kra"ia' da" (ri=r da" dmi'i"a*i @a% -r$ar"a (u%ih (ada !%ak da(a% %r)adi (ada d/*i"*i >i%ami" 12. A"a'i*i* (a%!'!#i m"+a%aka" *-uah Dd#"ra*i (!riE kar"a hi'a"#"+a da" (m-"#kaka" *'u-u"# mi'i". d#"ra*i i"i %r'iha% (ada MRI. U"%uk a'a*a" +a"# %idak )'a* %i"#ka% k(araha" a"mia m#a'!-'a*%ik -r-a"di"# %r-a'ik d"#a" %i"#ka% di*=u"#*i *ara=. !"di*i %idak -ia*a +a"# %rkai% d"#a" >i%ami" 12 *(r%i #'!*i%i* ma'a-*!r(*i i"=r%i'i%a* da" %r!m-!*i*. Tr!m-!*i* *udah dikai%ka" d"#a" di%a"dai hi(r!m!*i*%i"mia (ada --ra(a ka*u* d/*i*"*i >i%ami" 12. Trkada"# (a*i" d"#a" hi(r(i#m"%a*i +a"# m"u")uka" *da"# da'am ("#!-a%a".

PENYEBAB KEKURANGAN VITAMIN B12

 Ta-' 1 da" Gam-ar 3 ada'ah da=%ar ("+-a- kkura"#a" i%ami" 12 da" ma"a)m" +a"# dia")urka". a"mia (r"i*i!*a di-aha* di -a$ah i"i kar"a i"i ada'ah ("+-a- (a'i"# umum dari kkura"#a" i%ami" 12 +a"# (arah di *'uruh du"ia. di% kkura"#a" i%ami" 12 (ada -a+i da" a"aka"ak )u#a di-aha* kar"a ("#akua" m"i"#ka%"+a k'ai"a" -ra% (ada k*k'u*i= -a+i +a"# m"da(a% ASI dari i-u +a"# kkura"#a" i%ami" 12.  Anemia pernisiosa A"mia (r"i*i!*a ada'ah ("+aki% au%!imu" #a*%ri%i* +a"# m"+-a-ka" d*%ruk*i (ada *' (ari"%a' 'am-u"# da" kura"#"+a =ak%!r i"%ri"*ik u"%uk m"#ika% i%ami" 12. Ga*%ri%i* au%!imu" da(a% m"+-a-ka" ma'a-*!r(*i @a% -*i d"#a" kkura"#a" @a% -*i k'i"i* -rkm-a"# (ada a$a' khidu(a" da" akhir"+a ma)u k ma'a-*!r(*i i%ami" 12. (ra'"*i a"mia (r"i*i!*a -rki*ar &04000 ka*u* (r 100.000 !ra"# %r#a"%u"# (ada kri%ria dia#"!*%ik. *mua k'!m(!k umur +a"# di("#aruhi %%a(i r"%a"# u*ia mdia" da'am *ri -*ar ada'ah 70 hi"##a ,0 %ahu". a"mia (r"i*i!*a '-ih *ri"# %r)adi (ada !ra"# dari A=rika a%au r!(a k%uru"a" 43 da" (ra'"*i 4.0 di a"%ara !ra"# d$a*a +a"# '-ih %ua ma*i"#ma*i"# di-a"di"#ka" (ada mrka dari k%uru"a" A*ia d"#a" -"%uk +a"# '-ih ri"#a". Defsiensi diet di masa bayi dan anak 

Ma"i=*%a*i kha* d/*i"*i i%ami" 12 (ada a"aka"ak %rma*uk k#a#a'a" (r%um-uha" *ara k*'uruha" (rkm-a"#a" !%ak da" ("#m-a"#a" r#r*i (rkm-a"#a" h+(%!"ia k*u'i%a" maka" '*u %rm!r h+(rirri%a-i'i%+ da" k!ma #am-ar 2. "##a"%ia" >i%. 12 mm-rika" ha*i' +a"# -a#u* dima"a -a"+ak -a+i +a"# (u'ih *("uh"+a. Namu" *maki" 'ama (ri!d kkura"#a" *maki" -*ar kmu"#ki"a" -ah$a aka" ada aa% (rma"". i-u dari -a+i d"#a" d/*i"*i i%ami" 12 *ri"# mmi'iki a"mia (r"i*i!*a +a"# -'um diakui %%a(i a'%r"a%i= mrka mu"#ki" mmi'iki *)arah !(ra*i -+(a** 'am-u"# *i"dr!m u*u* ("dk a%au )a"#ka (a")a"# #%aria" a%au #a" *(%r!mr+ ma**a di%. Ta"dm di *'uruh &0 "#ara  da(a% m"d%k*i d/*i"*i 12 #i@i kar"a ("i"#ka%a" (r!(i!"i' ar"i%i" %%a(i ("#ukura" 'a"#*u"# dari a*am m%h+'ma'!"i mmi'iki *"*i%ii%a* +a"# '-ih %i"##i. ("+-a- 'ai" d/*i"*i 12 (ada a"ak a"ak *(r%i r*k*i i'um *i"dr!m imr*'u"d#ra*-k ("+aki% i"9ama*i u*u* da" a"mia +a"# mru*ak %ra"%um da'am %a-' 1. STRATEGI DAN BUKTI

Evaluasi  S-uah ("dka%a" u"%uk ("#u)ia" di%u")ukka" (ada La-!ra%!rium "#u)ia" di >i%ami" 12 C/*i"*i. S)arah (a*i" mu"#ki" %rma*uk #)a'a a"mia #a"##ua" +a"# m"da*ari m"+-a-ka" ma'a-*!r(*i da" #)a'a "ur!'!#i*. G)a'a "ur!'!#i* +a"# (a'i"# umum ada'ah (ar*%*ia *im%ri* a%au ma%i ra*a da" ki(rah (r!-'m*. 4& mrik*aa" /*ik da(a% m"#u"#ka(ka" (ua% dma (ru-aha" (i#m" di ku'i% *aki% ku"i"# a%au aa% "ur!'!#i* *(r%i #a"##ua" #%ara" ra*a (!*i*i #a"##ua" da" *"*a*i ku'i% a%ak*ia  da" k'maha" Gam-ar 2. i!(*i *um*um %u'a"# da" a*(ira*i %idak di(r'uka" u"%uk dia#"!*i* a"mia m#a'!-'a*%ik da" da(a% m"+*a%ka" da'am ka*u* (a"*i%!("ia -ra% d"#a" h+(r''u'ari%+ m"i"#ka% r+%hr!-'a*%* da" -ahka" k'ai"a" *i%!#"%ik mm-i"#u"#ka" dia#"!*i* d"#a" "i%raa" 'ukmia. Tes Vitamin B12  T* (r%ama di'akuka" u"%uk m"#k!"/rma*i dia#"!*i* kkura"#a" i%ami" 12 umum"+a ("#ukura" %i"#ka% *rum i%ami" 12  . M*ki(u" %i"#ka% +a"# *a"#a% r"dah ;100 (# (r mi'i'i%r H;73, (m!' (r 'i%r -ia*a"+a -rhu-u"#a" d"#a" kkura"#a" k'i"i* %i"#ka% r"dah %r*-u%  )ara"# diama%i. dua m'iha% "i'ai"i'ai (!*i%i= da" "#a%i= (a'*u. C"#a" m"##u"aka" -a%a* 'a-. a"# di'a(!rka" '-ih r"dah dari ki*ara" "!rma'

*-a#ai %i%ik u%!K u"%uk d/*i"*i. T* -aru h!'!%ra"* !-a'ami" mm-rika" ("i"#ka%a" *(*i/%a* (ada *rum >i%. 12 Pengukuran Serum Asam methylmaloni dan Total !omosistein "#ukura" a*am m%h+'ma'!"i )um'ah h!m!+*%i" a%au kdua"+a -r#u"a da'am mm-ua% dia#"!*i* d/*i"*i i%ami" 12 (ada (a*i" +a"# -'um m"rima %ra%m"%. Ti"#ka% kdua a*am m%h+'ma'!"i da" )um'ah h!m!*i*%i" +a"# "+a%a m"i"#ka% di *-a#ia" -*ar  8, (a*i" d"#a" d/*i"*i 12. "i"#ka%a" kadar a*am m%h+'ma'!"i da" )um'ah ("uru"a" h!m!*i*%i" *%'ah (ra$a%a" da(a% diukur km-a'i u"%uk m"d!kum"%a*ika" ("##a"%i i%ami" 12 +a"# mmadai. Ti"#ka% m%a-!'i% i"i "!rma' *am(ai d"#a" &0 dari (a*i" d"#a" kadar i%ami" 12 +a"# r"dah +a"# %idak mmi'iki hma%!'!#i a%au r*(!" "ur!'!#i* u"%uk %ra(i ("##a"%i. Ti"#ka% +a"# '-ih %i"##i dari a*am m%h+'ma'!"i uku( *(*i/k u"%uk d/*i"*i i%ami" 12. TES UNTUK MENENTUKAN PENYEBAB DEFISIENSI VITAMIN B 12

Ma'a-*!r(*i -ia*a"+a %r)adi (ada (a*i" d"#a" k!*um*i i%ami" 12 +a"# uku( da" %'ah dik!"/rma*i m"#a'ami d/*i"*i 12. "#u)ia" u"%uk a"mia (r"i*i!*a di)'a*ka" di Ta-' 2. 5a*i' (!*i%i= +a"# di%muka" (ada ("#u)ia" a"%i=ak%!r i"%ri"*ik a%au a"%i*' (ari%a' 'am-u"# m"#i"dika*ika" %r)adi"+a a"mia (r"i*i!*a ("#a$a*a" %rhada( ("+aki% %ir!id +a"# di*-a-ka" au%!imu" )u#a 'a+ak di'akuka" (ada (a*i" d"#a" %mua" (!*i%i= (ada ("#u)ia" a"%i-!di. Ga*%ri%i* a%r!/ kr!"ik da(a% didia#"!*a a%a* da*ar ("i"#ka%a" kadar *rum #a*%ri" (ua*a da" ("uru"a" kadar *rum ((*i"!#" I. -ra(a ah'i m"+ara"ka" u"%uk di'akuka""+a "d!*k!(i (ada (a*i" u"%uk m+aki"ka" ada"+a rada"# 'am-u"# #a*%ri%i* da" m"+i"#kirka" kmu"#ki"a" %r)adi"+a k#a"a*a" a%au ka"kr 'am-u"# 'ai""+a ha' i"i di'akuka" m"#i"#a% ada"+a ("i"#ka%a" ri*ik! %r)adi k#a"a*a" 'am-u"# (ada (a*i" a"mia (r"i*i!*a.  T* Shi''i"# a-*!r(*i radi!ak%i= i%ami" 12 %idak 'a#i di'akuka". S-uah %* ("##a"%i u"%uk m"#u)i a-*!r(*i i%ami" 12  *da"# da'am (r!** (rkm-a"#a" dima"a ("i"#ka%a" *a%ura*i i%ami" 12  dari h!'!%ra"*k!-a'ami" di%muka" *%'ah --ra(a hari di'akuka" (m-ria" 12 (r !ra' "amu" ha' i"i ma*ih mmr'uka" ("'i%ua" '-ih 'a")u%.

PENGOBATAN DEFISIENSI VITAMIN B12

-u%uha" haria" u"%uk i%ami" 12 *ki%ar 24 # %a(i da(a% '-ih %i"##i )um'ah"+a *ki%ar 27 #Bhari. ada umum"+a !ra"# +a"# mmaka" da#i"# a%au m"#k!"*um*i mu'%ii%ami" *%ia( hari"+a di k'!m(!kka" d"#a" )um'ah a*am m%i'ma'!"i +a"# '-ih r"dah. Ora"# d$a*a '-ih %ua haru* mm(r%im-a"#ka" m"#k!"*um*i *u('m" i%ami" 12 ri*%a +a"# dirk!m"da*ika" !'h F!!d a"d Nu%ri%i!" !ard. Namu" k-a"+aka" (a*i" d"#a" d/*i"*i i%ami" 12 mmi'iki #)a'a k'i"i* ma'a-*!r-*i da" aka" mmr'uka" (ar"%ra' a%au ("##a"%ia" d!*i* !ra' +a"# '-ih %i"##i. 5a*i' *u('m"%a*i +a"# adkua% ada'ah r*!'u*i u"%uk a"mia m#a'!-'a*%ik da" mm(r-aiki ("+aki% m+'!(a%+. "n#eksi vitamin B 12 a"+ak rk!m"da*i u"%uk i")k*i i%ami" 12 di"amaka" +a"!!-a'ami" di Amrika Srika% da" hidr!!!-a'ami" di r!(a *ki%ar 10 d!*i* i")k*i 1001000 # di(r%aha"ka". a*i" d"#a" k'ai"a" -ra% haru* m"rima i")k*i 1000 # *diki%"+a --ra(a ka'i (rmi"##u u"%uk 12 mi"##u kmudia" ("#!-a%a" --ra(a mi"##u *am(ai (r-aika" +a"# di%u")ukka". Ciiku%i d"#a" *u"%ika" (r-u'a". R*(!" hma%!'!#i +a"# (a% d"#a" ("i"#ka%a" )um'ah r%iku'!*i% da'am *a%u mi"##u da" (r-aika" a"mia m#a'!-'a*%ik 6, mi"##u. a*i" d"#a" a"mia -ra% da" #)a'a ("+aki% )a"%u"# haru* di%a"#a"i" d"#a" di%ra"=u*i da" a#" diur%i da" 'k%r!'i% haru* di(a"%au. G)a'a "ur!'!#i* da(a% mm(r-uruk %ra"*i"%'+ da" mrda *'ama --ra(a mi"##u k -u'a" %i"#ka% k(araha" da" dura*i dari a-"!rma' "ur!'!#i* *-'um ("#aruh ("+m-uha" dari %i"#aka% akhir k*m-uha". Dosis tinggi pengobatan oral  C!*i* ("#!-a%a" !ra' +a"# %i"##i *a"#a% =k%i= da" *maki" (!(u'r. S-uah *%udi +a"# di'akuka" 4& %ahu" +a"# 'a'u m"u")ukka" -ah$a 0&4 dari radi!ak%i= -r'a-' 'i*a" i%ami" 12 da(a% di*ra( !'h di=u*i (a*i= di kdua k!"%r!' "!rma' da" (a*i" d"#a" a"mia (r"i*i!*a. d"#a" dmikia" d!*i* !ra' 1000 mikr!#ram mm-rika" & *am(ai 40 mikr!#ram. ILAYAH KETIDAKPASTIAN

kura"#a" i%ami" 12 ada'ah ("+-au%ama h+(rh!m!+*%i"mia di "#ara"#ara d"#a" =!'a% maka"a" +a"# di(rka+a *(r%i Amrika Srika% da" a"ada. S%udi (idmi!'!#i m"u")ukka" hu-u"#a" +a"# *i#"i/ka" a"%ara ("i"#ka%a" kadar h!m!*i*%i" da" ("+aki% (m-u'uh darah da" %r!m-!*i*. Namu" (r!-aa" aak -*ar dik!m-i"a*ika" %ra(i i%ami"  d!*i* %i"##i (ada

(a*i" d"#a" ("+aki% (m-u'uh darah m"u")ukka" %idak ada ("uru"a" k)adia" a*ku'ar. S%a%u* 12 i%ami" haru* dia'ua*i (ada (a*i" d"#a" h+(rh!m!+*%i"mia *-'um ("#!-a%a" a*am =!'a% dimu'ai. ra" (!%"*ia' kkura"#a" i%ami" 12 ri"#a" (ada ("uru"a" k!#"i%i=  d"#a" ("uaa" ma*ih -'um )'a*. S%udi (idmi!'!#i m"u")ukka" hu-u"#a" %r-a'ik a"%ara *u('m"%a*i i%ami" 12 da" ("+aki% "ur!d#"ra%i %%a(i ha*i' dari (r!-aa" aak %'ah *-a#ia" -*ar "#a%i=. S'ai" %a-'% 'i*a" i%ami"  %r*dia da'am (r*ia(a" *u-'i"#ua' *m(r!%a" mu'u% hidu"# a%au #' *m(r!%a" da" (a%h %ra"*drma'. Ca%a (ada ("+ra(a" da" kma")ura" i"i (r*ia(a" a'%r"a%i= ma*ih kura"#. GUIDELINES

d!ma" #i@i u"%uk a*u(a" i%ami" 12 +a"# di%r-i%ka" !'h C$a" a"#a" da" Gi@i  da" (d!ma" #i@i u"%uk #%aria" +a"# di%r-i%ka" !'h Amria" Ci%%i A**!ia%i!" . Tidak ada rk!m"da*i dari Amria" S!i%+ != 5ma%!'!#+ u"%uk dia#"!*i* da" ("#!-a%a" d/*i"*i i%ami" 12. Amria" Aadm+ != Nur!'!#+ mrk!m"da*ika" ("#ukura" i%ami" 12  a*am m%h+'ma'!"i  da" h!m!*i*%i" (ada (a*i" d"#a" (!'i"ur!(a%i *im%ri* . Amria" S!i%+ =!r Ga*%r!i"%*%i"a' "d!*!(+ mrk!m"da*ika" a'ua*i "d!*k!(i %u"##a' (ada dia#"!*i* a"mia (r"i*i!*a .

KESIMPULAN DAN REKOMENDASI

a*i" da'am *k%*a mmi'iki k'ai"a" "ur!'!#i* +a"# k!"*i*%" d"#a" kkura"#a" i%ami" 12. S)ak kadar i%ami" 12 dia%a* mu"#ki" di-a$ah ki*ara" r=r"*i 'a-!ra%!rium -ahka" (ada (a*i" d"#a" d/*i"*i k'i"i* a*am m%h+'ma'!"i )um'ah h!m!+*%i" a%au kdua"+a haru* diukur u"%uk m"d!kum"%a*ika" kkura"#a" i%ami" 12 *-'um ("#!-a%a" dimu'ai %i"#ka% %i"##i (ada (a*i" i"i m"#k!"/rma*ika" dia#"!*i*. C"#a" %idak ada"+a (m-a%a*a" di% a%au dik%ahui ("+-a- ma'a-*!r(*i a'ua*i '-ih 'a")u% di(r'uka"  khu*u*"+a ("#u)ia" u"%uk a"mia (r"i*i!*a =ak%!r a"%i-!di a"%i i"%ri"*ik. "%ah (ar"%ra' (ra$a%a" i%ami" 12 ,10 *u"%ika"

(mua%a" 1000 u# ma*i"#ma*i"# diiku%i !'h *u"%ika" 1000u# -u'a"a" a%au d!*i* %i"##i i%ami" 12 'i*a" ("#!-a%a" 10002000 m# *hari mru(aka" %ra(i +a"# =k%i=. Sa+a aka" m"i")au kdua (i'iha" %rma*uk kmu"#ki"a" diri i")k*i di rumah d"#a" (a*i". >i%ami" ("##a"%i +a"# =k%i= aka" mm(r-aiki )um'ah darah da'am 2 -u'a" da" -"ar a%au mm(r-aiki %a"da%a"da da" #)a'a "ur!'!#i* da'am $ak%u 6 -u'a".