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Adie MA, Martes Gomez M, Yom J, Durand M, Wertheimer F, McGowan R, Yano S, Ramanathan R. Twin Premature Infants With Riboflavin and Biotin Deficiency Presenting With Refractory Lactic Acidosis, Rash, and Multiorgan Failure During Prolonged Parenteral Nutrition. J Investig Med High Impact Case Rep 2023; 11:23247096231168111. [PMID: 37085971 PMCID: PMC10126694 DOI: 10.1177/23247096231168111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/23/2023] Open
Abstract
We are reporting monochorionic, diamniotic twin premature infants born at 25 weeks and 6 days gestation with riboflavin (vitamin B2) and biotin (vitamin B7) deficiency, while on prolonged total parenteral nutrition (TPN) during vitamin shortage. They presented initially with skin rash, lactic acidosis, and thrombocytopenia. Both twins progressed to severe respiratory failure, severe lactic acidosis, with refractory vasodilatory shock, pancytopenia, ischemic bowel injury, acute kidney injury, liver injury, and capillary leak syndrome leading to death of twin A. The surviving twin B was diagnosed with riboflavin and biotin deficiency that presented with abnormal metabolic work up suggestive of maple syrup urine disease, glutaric acidemia type 2, and X-linked adrenoleukodystrophy. Twin B was started on riboflavin and biotin supplementation at 41 days of life, with rapid improvement in clinical findings and laboratory abnormalities within days of starting biotin and riboflavin supplementation. He was discharged home in stable condition at 49 weeks of postmenstrual age.
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Affiliation(s)
- Mohammad Amin Adie
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Maria Martes Gomez
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Jessica Yom
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Manuel Durand
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Fiona Wertheimer
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Rachel McGowan
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Shoji Yano
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Keck School of Medicine of University
of Southern California, LAC+USC Medical Center, Los Angeles, CA, USA
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Northrop-Clewes CA, Thurnham DI. Biomarkers for the differentiation of anemia and their clinical usefulness. J Blood Med 2013; 4:11-22. [PMID: 23687454 PMCID: PMC3610441 DOI: 10.2147/jbm.s29212] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The World Health Organization defines anemia as the point at which the amount of hemoglobin in the circulation falls below World Health Organization cutoffs for specific age and sex groups. Anemia is a worldwide problem of complex etiology and is associated with many factors. The purpose of this review was to describe the biomarkers used to identify the nature of anemia in patients and in the community. The important biomarkers are the automated red cell counts, tests for nutritional deficiencies, hemoglobinopathies, and inflammation. Diseases are important potential initiators of anemia, but biomarkers of specific diseases are not included in this review, only the underlying feature common to all disease - namely, inflammation.
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Affiliation(s)
| | - David I Thurnham
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine, UK
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Rohner F, Zimmermann MB, Wegmueller R, Tschannen AB, Hurrell RF. Mild riboflavin deficiency is highly prevalent in school-age children but does not increase risk for anaemia in Côte d'Ivoire. Br J Nutr 2007; 97:970-6. [PMID: 17381972 DOI: 10.1017/s0007114507665180] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There are few data on the prevalence of riboflavin deficiency in sub-Saharan Africa, and it remains unclear whether riboflavin status influences the risk for anaemia. The aims of this study were to: (1) measure the prevalence of riboflavin deficiency in children in south-central Côte d'Ivoire; (2) estimate the riboflavin content of the local diet; and (3) determine if riboflavin deficiency predicts anaemia and/or iron deficiency. In 5- to 15-year-old children (n281), height, weight, haemoglobin (Hb), whole blood zinc protoporphyrin (ZPP), erythrocyte glutathione reductase activity coefficient (EGRAC), serum retinol, C-reactive protein (CRP) and prevalence ofPlasmodiumspp. (asymptomatic malaria) andSchistosoma haematobium(bilharziosis) infections were measured. Three-day weighed food records were kept in twenty-four households. Prevalence of anaemia in the sample was 52 %; 59 % were iron-deficient based on an elevated ZPP concentration, and 36 % suffered from iron deficiency anaemia.Plasmodiumparasitaemia was found in 49 % of the children. Nineteen percent of the children were infected withS. haematobium. Median riboflavin intake in 5- to 15-year-old children from the food records was 0·42 mg/d, ~47 % of the estimated average requirement for this age group. Prevalence of riboflavin deficiency was 65 %, as defined by an EGRAC value >1·2. Age, elevated CRP and iron deficiency were significant predictors of Hb. Riboflavin-deficient children free of malaria were more likely to be iron deficient (odds ratio; 3·07; 95 % CI 1·12, 8·41). In conclusion, nearly two-thirds of school-age children in south-central Côte d'Ivoire are mildly riboflavin deficient. Riboflavin deficiency did not predict Hb and/or anaemia, but did predict iron deficiency among children free of malaria.
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Affiliation(s)
- Fabian Rohner
- Human Nutrition Laboratory, Institute of Food Science and Nutrition, ETH Zurich, Schmelzbergstrasse 7, 8092 Ziirich, Switzerland.
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FOY H, KONDI A, MBAYA V. Effect of riboflavine deficiency on bone marrow function and protein metabolism in baboons. Preliminary report. Br J Nutr 2007; 18:307-18. [PMID: 14188290 DOI: 10.1079/bjn19640029] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Riboflavin is unique among the water-soluble vitamins in that milk and dairy products make the greatest contribution to its intake in Western diets. Meat and fish are also good sources of riboflavin, and certain fruit and vegetables, especially dark-green vegetables, contain reasonably high concentrations. Biochemical signs of depletion arise within only a few days of dietary deprivation. Poor riboflavin status in Western countries seems to be of most concern for the elderly and adolescents, despite the diversity of riboflavin-rich foods available. However, discrepancies between dietary intake data and biochemical data suggest either that requirements are higher than hitherto thought or that biochemical thresholds for deficiency are inappropriate. This article reviews current evidence that diets low in riboflavin present specific health risks. There is reasonably good evidence that poor riboflavin status interferes with iron handling and contributes to the etiology of anemia when iron intakes are low. Various mechanisms for this have been proposed, including effects on the gastrointestinal tract that might compromise the handling of other nutrients. Riboflavin deficiency has been implicated as a risk factor for cancer, although this has not been satisfactorily established in humans. Current interest is focused on the role that riboflavin plays in determining circulating concentrations of homocysteine, a risk factor for cardiovascular disease. Other mechanisms have been proposed for a protective role of riboflavin in ischemia reperfusion injury; this requires further study. Riboflavin deficiency may exert some of its effects by reducing the metabolism of other B vitamins, notably folate and vitamin B-6.
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Affiliation(s)
- Hilary J Powers
- Centre for Human Nutrition, The University of Sheffield, United Kingdom.
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EDOZIEN JC, ADENIYI-JONES C, WATSON-WILLIAMS EJ. Serum proteins and hepatic function in pregnancy with anaemia in Nigerian women. BRITISH MEDICAL JOURNAL 1998; 1:333-6. [PMID: 13725745 PMCID: PMC1952804 DOI: 10.1136/bmj.1.5222.333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Powers HJ. Riboflavin-iron interactions with particular emphasis on the gastrointestinal tract. Proc Nutr Soc 1995; 54:509-17. [PMID: 8524897 DOI: 10.1079/pns19950019] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- H J Powers
- University Department of Paediatrics, Sheffield Children's Hospital
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Abdalla SH, Corrah PT, Mabey DC. Severe megaloblastic anaemia due to vitamin B12 deficiency in The Gambia. Trans R Soc Trop Med Hyg 1986; 80:557-62. [PMID: 3810788 DOI: 10.1016/0035-9203(86)90138-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Five cases of severe megaloblastic anaemia in Gambians are described. Three of the patients were found to have pernicious anaemia. The difficulties in diagnosis and the various features of pernicious anaemia in Negroes are discussed. A brief review of the literature is included.
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Coward WA, Whitehead RG. Changes in haemoglobin concentrations during the development of kwashiorkor. Br J Nutr 1972; 28:463-71. [PMID: 4628635 DOI: 10.1079/bjn19720057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Foy H, Kondi A. Comparison between erythroid aplasia in marasmus and kwashiorkor and the experimentally induced erythroid aplasia in baboons by riboflavin deficiency. VITAMINS AND HORMONES 1969; 26:653-84. [PMID: 4975852 DOI: 10.1016/s0083-6729(08)60780-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Lothe F, Patel KM, Tozer RA. Megaloblastic anaemia in Uganda. Trans R Soc Trop Med Hyg 1969; 63:393-7. [PMID: 5795163 DOI: 10.1016/0035-9203(69)90017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Kondi A, Foy H, Mbaya V. Erythroid aplasia in riboflavin-deficient baboons and its relation to marasmus and kwashiorkor. Br J Haematol 1967; 13:967-76. [PMID: 4965450 DOI: 10.1111/j.1365-2141.1967.tb08867.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cowan B, Joseph S, Satija VK. The gastric mucosa in anaemia in Punjabis: Part I In iron-deficiency anaemia. Gut 1966; 7:234-8. [PMID: 18668799 PMCID: PMC1552403 DOI: 10.1136/gut.7.3.234] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Khan AA. Practical aspects of the treatment of hookworm infection in Kampala children. Trans R Soc Trop Med Hyg 1966; 60:770-3. [PMID: 5954291 DOI: 10.1016/0035-9203(66)90227-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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BISSERU B, GIBB WE. Medical memorandum. Trans R Soc Trop Med Hyg 1963; 57:458-9. [PMID: 14081302 DOI: 10.1016/0035-9203(63)90080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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TURNER PP. Megaloblastic anaemia in Africans at the Coast Province General Hospital during 1960. Trans R Soc Trop Med Hyg 1963; 57:34-40. [PMID: 13994911 DOI: 10.1016/0035-9203(63)90009-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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ADAMS EB, HIFT W. Nutritional and other megaloblastic anaemias among Africans and Indians in Durban. Trans R Soc Trop Med Hyg 1961; 55:374-82. [PMID: 13681371 DOI: 10.1016/0035-9203(61)90107-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Affiliation(s)
- J. Kariks
- Department of Public Health Port Moresby Territory of Papua and New Guinea
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