Severe Vit D deficiency with Vit B12 deficiency and IDA

A 31 year female, teacher by profession reported to OPD after getting her several tests done Chief Complaints She complaints of generalised body ache and weakness whole day while at school and feel like sleeping, even after a good night sleep for last 2 months Vitals Vitals are wnl Investigations Hb - 11.1 Serum 25(OH) D - 5.56 Vit B12 - 134 TSAT - 9 % (Low) TIBC - High S. Iron - Low MCV is mildly low, and RDW is mild high So as per CBC and Iron studies she is into Iron deficiency anemia too Management As she was not willing for optineuron infusion IV for next 5 days, due to IV cannula being visible while at school, so I advised her - Inj Arachitol 6L unit Deep IM once weekly for 4 weeks, Inj Vitcofol C IM once daily for next 3 days, Tab Orofer XT total at bedtime, Tab Zinconia 50mg OD, Tab Limcee 500mg BD Kindly give me your valuable opinion on this case

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Your plan of supplementing iron and B 12 in view of deficiency of iron and B 12 is absolutely correct The choice of medication is also correct There may be variation in choice of medication and duration from one doctor to another doctor, none the less over all plan is very good Please update progress after 4 weeks

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Though your line of treatment is fine but you should focus on the counselling of such types of patients to stick with the advice given by you from time to time as she may again get into the same problem again if she discontinued the management plan as advised by you.

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Apart from treatment given.. also tryto find out the cause of dimorphic anaemia. Is it nutritional? Rule out malabsorption.. and bleeding diathesis... Go for.. stool obt for 3 days Also.. folic acid assay.. And add. Folate supplement

Sir, nice workup , I would suggest To get her TFTs too, anaemia alone with Hb 11 can't explain her symptoms, I would go for her cardiac evaluation as well U can choose b12 I/M also, Arachitol 6l once is good enough I guess Rest all is good Would appreciate Ur follow up feedback Good job done

Sir, I think TFT was done, and it was normal too. Will check it again on follow up visit and update here Yes sir B12 I have given IM only, before I was planning for IV infusion, but for her working at school with an IV cannula was bothersome Sir, please tell me that is three doses of vitcofol C inj in 3 days straight, followed by weekly Vitcofol C for 4 weeks, good enough?
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Known pt of iron deficiency High tibc Low tsat Upfe100 hs Inj architol6 lac im weekly 3 Then calciferol sachet once a week 3 month once a month9 month Inj vitcofol 2 cc im10 Anaemia low vitamin d low b12

Sir - You are on the right track Hb -,11.1 cannot be called anaemia by Indian standards in females . Supplementing B12 and Vitamin- D is appropriate as per her reports

Dimorphic anemia. Adv dual correction of iron and vit B12 folic acid.

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YOUR LINE OF T/T IS CORRECT.. CONTINUE WITH THE SAME.. VITAMIN D3 MUST 60 K X WKLY.. WITH.. FOLLOW UP.. AND .. GOOD HEALTH AND HYGIENE...

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Your management for defences mention Dietary supplements also importent u can add Otherwise no other option of TT LEFT BIHIND

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Continue Same Fruits High protein diet Eggs Chicken Naturolax powder 2 tsf bd

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