A Blurb on B12 and Neurology

     Ok so real quick, pernicious anemia is due to a decrease production of intrinsic factor, decreased B12 absorption in the terminal ilium, or decreased dietary intake of B12. The symptoms are known as the "5 P's" (pancytopenia, peripheral neuropathy, posterior spinal column neuropathy, pyramidal tract signs, ans papillary (tongue) atrophy).  B12 has two functions in the body. First, is works with nucleic acid synthesis through the regeneration of tetrahydrofolate. What's even cooler is that it is also a co-factor of methylmalonyl COA mutase. This enzyme breaks down branched and odd carbon fatty acids. If this fatty acid breakdown does not occur, then the fat gets incorporated into the myelin sheets and causes neuropathy. That's why when you treat a patient with folate, the hematologic symptoms get resolved but not the neurological. Whatever, I thought that was cool.