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Total gastrectomy 후 vitamin B12 투여에 대한 표준안이 없는 것 같습니다.
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Total gastrectomy 후 vitamin B12 deficiency가 발생할 수 있습니다. 이로 인한 megaloblastic anemia는 오히려 사소한 문제입니다. 심각하고도 비가역적인 neurologic complication이 발생할 수 있다는 점이 더 걱정이지요. 저는 오래 전에transverse myelitis가 발생한 환자에 대하여 consult를 해 드린 경험이 있습니다. 관련 논문 하나 소개합니다.
[Toskes PP. Hematologic abnormalities following gastric resection. Major Probl Clin Surg 1976;20:119-28]
The anemia observed in patients with partial gastric resection results from a complex interrelationship of deficiencies of these three important hematemics-iron, vitamin B12, and folic acid. Reliance upon morphological evidence of anemia in the peripheral blood smear may be difficult and confusing since deficiency of one hematemic may mask the coexisting deficiency of another. It is common for deficiencies of more than one hematemic to occur in these patients.
It is our policy at the University of Florida to rely on serum levels of these three hematemics, especially vitamin B12 and iron, to detect the cause of the anemia in a patient with partial gastric resection. Less reliance is placed upon the appearance of the peripheral smear because of the masking effect described above. If either the serum iron level or vitamin B12 level is decreased, we treat the patient with a preparation such as ferrous sulfate (300 mg. orally three times a day) and vitamin B12 (100 mug. intramuscularly once a month). We are less concerned with folic acid deficiency because of its relatively infrequent occurrence in this setting and because a good diet will usually suffice as adequate therapy for the folic acid deficiency when present.
Indeed, because of the serious complications of vitamin B12 deficiency and the observations that deficiencies of this vitamin may occur even when the absorption of crystalline vitamin B12 is normal in the fasting state (the conventional Schilling test), some authors, such as Rygvold, have suggested that prophylactic vitamin B12 be administered to all patients with partial gastric resection.
2014. 6. 22. 이준행