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Bahardoust M, Mousavi S, Ziafati H, Alipour H, Haghmoradi M, Olamaeian F, Tayebi A, Tizmaghz A. Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis. Eur J Cancer Prev 2024; 33:208-216. [PMID: 37669168 DOI: 10.1097/cej.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Nutrient deficiency is one of the common complications in patients who undergo gastrectomy, especially those vitamins and minerals absorbed in the stomach or by substances in the gastric juice, such as vitamin B12. Hence, this systematic review and meta-analysis were conducted for the first time to investigate the prevalence of vitamin B12 deficiency and its symptoms in gastric cancer (GC) patients who underwent gastrectomy. METHOD PubMed, Scopus, Google Scholar, and Web of Science databases were searched to find related studies. After screening, studies were selected based on the abstract and title of related studies. The heterogeneity and inconsistency between studies were evaluated using Cochran's Q, I 2 tests. Egger's test analyzed publication bias for studies. A 95% confidence interval (95% CI) was used to estimate the overall prevalence of vitamin B12 deficiency. RESULTS Fourteen studies, including 2627 GC patients who underwent surgery, were included in the study. The mean age of the patients in this study was 61.2 ± 4.93 years. The pooled estimate of meta-analysis results showed that the prevalence of vitamin B12 deficiency after gastrectomy in patients with GC was 48.8% (95% CI:32.4, 65.2%, I 2 : 98.85, τ 2 = 0.05, Q (13) = 1127.8, P < 0.001). The most important symptoms were anemia, fatigability, cold feet or legs, numbness, and dizziness. CONCLUSION AND RECOMMENDATION Vitamin B12 deficiency has a high prevalence among patients who have undergone gastrectomy, and it is necessary to pay enough attention to treating these patients after surgery to prevent its complications.
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Affiliation(s)
- Mansour Bahardoust
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safa Mousavi
- Department of Public Health, College of Health and Human Services, California State University, Fresno, California, USA
| | - Hassan Ziafati
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | | | - Meisam Haghmoradi
- Department of Orthopedic Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Faranak Olamaeian
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | - Ali Tayebi
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | - Adnan Tizmaghz
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
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2
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Verónica B, Crespo C, Lochner N, Rossetti E, Tagliavini C, Bouso C, Eiroa H. New data supporting that early diagnosis and treatment are possible and necessary in intracellular cobalamin depletion: the case of transcobalamin II deficiency. J Pediatr Endocrinol Metab 2024; 37:380-386. [PMID: 38436354 DOI: 10.1515/jpem-2023-0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Transcobalamin II (TC) promotes the cellular uptake of cobalamin (Cbl) through receptor-mediated endocytosis of the TC-cbl complex in peripheral tissues. TC deficiency is a rare disorder that causes intracellular Cbl depletion. It presents in early infancy with a failure to thrive, diarrhea, anemia, agammaglobulinemia, and pancytopenia. Data from five TC-deficient patients including clinical, biochemical, and molecular findings, as well as long-term outcomes, were collected. CASE PRESENTATION Mutation analysis revealed one unreported pathogenic variant in the TCN2 gene. One patient had exocrine pancreatic insufficiency. We conducted a retrospective analysis of C3 and C3/C2 from dried blood samples, as this is implemented for newborn screening (NBS). We detected a marked increase in the C3/C2 ratio in two samples. Treatment was based on parenteral Cbl. Three patients treated before six months of age had an initial favorable outcome, whereas the two treated later or inadequately had neurological impairment. CONCLUSIONS This is the first report of Argentinean patients with TC deficiency that detected a new variant in TCN2. NBS may be a tool for the early detection of TC deficiency. This data emphasizes that TC deficiency is a severe disorder that requires early detection and long-term, aggressive therapy. Accurate diagnosis is imperative, because early detection and treatment can be life-saving.
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Affiliation(s)
- Bindi Verónica
- Deparment of Inborn Error of Metabolism, 36947 Hospital de Pediatría Juan P. Garrahan , Buenos Aires, Argentina
| | - Carolina Crespo
- Department of Genetics, Molecular Biology Laboratory, 36947 Hospital de Pediatría Prof Dr Juan P Garrahan , Buenos Aires, Argentina
| | - Noelia Lochner
- Deparment of Inborn Error of Metabolism, 36947 Hospital de Pediatría Juan P. Garrahan , Buenos Aires, Argentina
| | - Estefanía Rossetti
- Department of Hematology, 36947 Hospital de Pediatría Juan P. Garrahan , Buenos Aires, Argentina
| | - Cecilia Tagliavini
- Inborn Errors of Metabolism Laboratory, 36947 Hospital de Pediatría Juan P. Garrahan , Buenos Aires, Argentina
| | - Carolina Bouso
- Department of Immunology, 36947 Hospital de Pediatría Juan P. Garrahan , Buenos Aires, Argentina
| | - Hernan Eiroa
- Deparment of Inborn Error of Metabolism, 36947 Hospital de Pediatría Juan P. Garrahan , Buenos Aires, Argentina
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Mehta A, Lynch W, Jha P. Vitamin B 12 deficiency presenting as neck pain and cervical radiculopathy. BMJ Case Rep 2024; 17:e259696. [PMID: 38663893 PMCID: PMC11043693 DOI: 10.1136/bcr-2024-259696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Vitamin B12 is required for the formation of haematopoietic cells and the synthesis of myelin. Deficiency typically presents with fatigue and megaloblastic anaemia. Prolonged deficiency can cause neurological symptoms such as paresthesia, which can progress to subacute combined degeneration of the spinal cord. We describe an unusual presentation of B12 deficiency in a young man who was initially diagnosed and treated for cervical radiculopathy. This case highlights the challenges of diagnosing B12 deficiency in patients with neurologic but without haematologic, abnormalities. While the current incidence of B12 deficiency in developed countries is low, cases are likely to rise with the increased adoption of veganism. Clinicians should be aware of the variable presentations of B12 deficiency because delayed diagnosis and treatment increases morbidity and can cause irreversible neurological deficits.
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Affiliation(s)
- Ashin Mehta
- Medical School, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Whitney Lynch
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Tanc C, Yildiz I. Evaluation of Neurodevelopmental Screening Test Scores in Children with Vitamin B12 Deficiency. Neuropediatrics 2024; 55:97-103. [PMID: 38122810 DOI: 10.1055/s-0043-1777125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Vitamin B12 deficiency can lead to hematological findings, neurological symptoms, and neurodevelopmental delay. The aim of this study was to investigate the impact of vitamin B12 deficiency on the neurodevelopment of children. MATERIALS AND METHODS This study included 89 children aged between 6 and 24 months without any complaints; 44 of these were evaluated in the study group (serum vitamin B12 <300 pg/mL) and 45 in the control group (serum vitamin B12 ≥300 pg/mL). Denver Developmental Screening Test II (DDST-II) and the Social Communication Area Screening Test (SCAST) were evaluated in each participant. RESULTS The mean vitamin B12 level in the study group was 206.11 ± 9.1 pg/mL, and in the control group, it was 540.65 ± 24.1 pg/mL. When DDST-II results were analyzed, the rate of getting suspicious and abnormal results in the study group was significantly higher compared with the control group (p = 0.001). The rate of the "risky" SCAST results of the cases was found to be statistically significantly higher in the study group than in the control group (p = 0.003). Vitamin B12 values of patients with suspicious or abnormal DDST-II results and with risky SCAST results were found to be statistically significantly lower than those with normal neurodevelopmental screening tests results (p = 0.001 and p = 0.001, respectively). CONCLUSION Vitamin B12 deficiency can lead to neurodevelopmental delay in children, even in the absence of neurological and hematological symptoms or complaints, which highlights the importance of early detection and intervention of vitamin B12 deficiency.
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Affiliation(s)
- Ceren Tanc
- Department of Pediatrics, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Ismail Yildiz
- Department of Pediatrics, Faculty of Medicine, Yalova University, Yalova, Turkey
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5
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Dułak NA, Rytlewska M, Jaskólska M, Chmielewski M. A new perspective on vitamin B12 deficiency in rheumatology: a case-based review. Rheumatol Int 2024; 44:737-741. [PMID: 38294542 DOI: 10.1007/s00296-024-05539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
Vitamin B12 (cobalamin) deficiency is common in patients with rheumatic diseases. Pernicious anemia is a well-known cause, but recent reports suggest that autoimmune-derived deficiency may not be limited to this cause alone. Symptoms of low vitamin B12 concentration are often deceptive, mimicking and overlapping with symptoms of other conditions. Neuropsychiatric manifestations, anemia, and fatigue are frequently attributed to a rheumatic disease without further evaluation. In this study, we present three cases of patients with neuropathic pain, depression, fatigue, and muscle weakness, initially attributed to a rheumatic disease, which almost completely resolved after implementing vitamin B12 supplementation. Furthermore, we provide an overview of current scientific reports regarding the potential use of cobalamin in rheumatology. Treatment of pain and neuropathy, often very challenging in long-lasting rheumatic diseases, can be more effective after a course of vitamin B12, even when no apparent deficiency is detected in laboratory tests. Considering recent research demonstrating vitamin B12's nerve-protecting properties, we recommend that physicians should assess vitamin B12 levels early in the diagnostic process of rheumatic diseases. In specific cases, physicians should consider cobalamin supplementation regardless of vitamin B12 serum concentration.
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Affiliation(s)
- Natalia Aleksandra Dułak
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
| | - Magdalena Rytlewska
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marta Jaskólska
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Michał Chmielewski
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
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Fraga C, Losa A, Cascais I, Garrido C, Lachado A, Couto Guerra I, Bandeira A, Cleto E, Costa E. Severe Hemolytic Anemia: Atypical Presentation of Cobalamin Deficiency. J Pediatr Hematol Oncol 2024; 46:172-174. [PMID: 38408112 PMCID: PMC10956652 DOI: 10.1097/mph.0000000000002829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024]
Abstract
Two severe cases of hemolytic anemia are described in different pediatric age groups, both linked to severe cobalamin deficiency from distinct causes. The first case refers to an exclusively breastfed infant with vitamin deficit secondary to maternal impaired absorption. Apart from the neurological deficits present at diagnosis, he also presented with infantile epileptic spasms syndrome a few months after treatment while having normal cobalamin serum levels. The second case refers to an adolescent with long-term inadequate intake. The occurrence of severe hemolytic anemia in cobalamin deficiency is exceptionally rare.
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Affiliation(s)
- Carolina Fraga
- Department of Pediatrics, Centro Materno-Infantil de Norte, Centro Hospitalar Universitário de Santo António (CMIN, CHUdSA)
| | | | | | | | | | | | - Anabela Bandeira
- Center for Inborn Metabolic Diseases, CMIN-CHUdSA, Porto, Portugal
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Kumar P, Sukhija J, Nagarajan B, Sankhyan N. Infantile Vitamin B12 Deficiency with Reversible Acquired Vision Loss. Indian J Pediatr 2024; 91:310. [PMID: 37658283 DOI: 10.1007/s12098-023-04839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Pawan Kumar
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaspreet Sukhija
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Balamurugan Nagarajan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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8
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Leleu D, Denimal D. A case of functional vitamin B12 deficiency after recreational nitrous oxide use. Biochem Med (Zagreb) 2024; 34:010801. [PMID: 38125615 PMCID: PMC10731736 DOI: 10.11613/bm.2024.010801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/22/2023] [Indexed: 12/23/2023] Open
Abstract
The recreational use of nitrous oxide as laughing gas becomes a real public health issue among adolescents and young adults. Chronic use is deleterious and can lead to severe neurological disorders. Nitrous oxide inactivates vitamin B12, and the functional defect of vitamin B12 plays a major role in the pathogenesis of nitrous oxide-related neurological disorders. Here we report the case of a 22-year-old woman who came to the hospital after an unexplained loss of consciousness. She exhibited typical features of vitamin B12 or folate deficiency such as macrocytic anemia and hypersegmented neutrophils. However, serum concentrations of folate and vitamin B12 were normal. In contrast, circulating concentrations of total homocysteine and methylmalonic acid were significantly increased. These results clearly indicated a defect in vitamin B12 functions. The reason for this defect was clarified when she revealed that she had been consuming nitrous oxide recreationally for over a year. The present case points out the challenges in diagnosing vitamin B12 deficiency in the context of nitrous oxide abuse due to normal concentrations of total serum vitamin B12 in a significant proportion of cases. The medical community should be aware of how difficult it can be to interpret B12 status in this specific population.
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Affiliation(s)
- Damien Leleu
- Department of Clinical Biochemistry, Dijon University Hospital, Dijon, France
- National institute for health and medical research, University of Burgundy, Dijon, France
| | - Damien Denimal
- Department of Clinical Biochemistry, Dijon University Hospital, Dijon, France
- National institute for health and medical research, University of Burgundy, Dijon, France
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9
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Wang S, Li Z, Shi Y, Wang T, Jin W. Nitrous oxide induced subacute combined degeneration of the spine cord: A case report. Medicine (Baltimore) 2024; 103:e37032. [PMID: 38335379 PMCID: PMC10860927 DOI: 10.1097/md.0000000000037032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE In recent years, recreational use of inhaled nitrous oxide (N2O) is on the increase among young people, accompanied by a corresponding rise in reports about its toxicity. Subacute combined degeneration of the spine cord (SCD) is the typical clinical picture of the nervous system disorder caused by N2O intoxication, as a result of metabolic disturbance of vitamin B12. PATIENT CONCERNS, DIAGNOSES, INTERVENTIONS AND OUTCOMES We report a 28-year-old female of SCD due to prolonged use of N2O, presented with paresthesia and unsteady in walking progressing within 1 month. Symptoms gradually improved with the treatment of intramuscular injections of hydroxocobalamin combined with N2O abstinence, and the patient recovered completely with normal neurological examination after 4 months of follow-up. LESSONS Clinicians should be aware of the clinical features and pathogenesis of SCD caused by N2O intoxication in order to lead effective treatment as soon as possible. Recreational N2O use should always be considered as an etiology when dealing with patients presented with myelopathy and/or neuropathy suspected of vitamin B12 deficiency.
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Affiliation(s)
- Shuo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zhe Li
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yuanyuan Shi
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Tianjun Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wei Jin
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
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10
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Daniel Y, Freeman S. Not a Laughing Matter: When Nitrous Oxide Causes Functional Vitamin B12 Deficiency. R I Med J (2013) 2024; 107:13-15. [PMID: 38285744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Subacute combined degeneration (SCD) is an acquired neurologic complication from prolonged vitamin B12 deficiency. As a result of dorsal and lateral spinal cord column degeneration, patients present with a range of neurological symptoms, including paresthesias, ataxia, and muscle weakness. Without prompt treatment, irreversible nerve damage occurs. Here we present a young man who developed progressive ascending paresthesias and lower extremity weakness after escalated nitrous oxide use. This case highlights the importance of considering SCD from nitrous oxide toxicity when patients present with progressive ataxia, paresthesia, and lower extremity weakness.
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Affiliation(s)
- Yonathan Daniel
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sarah Freeman
- Attending Physician; Department of Medicine, The Warren Alpert Medical School of Brown University; Division of General Internal Medicine, Rhode Island Hospital, Providence, RI
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Orhan Kiliç B, Kiliç S, Özmert E, Tavares A, Konuksever D, Kubat G, Köksal BT. Evaluation of vitamin B 12 values at time of diagnosis in 0- to 36-month-old children with food allergies. Nutrition 2024; 118:112270. [PMID: 38007994 DOI: 10.1016/j.nut.2023.112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES The relationship between food allergies and vitamin B12 deficiency in young children remains unclear despite extensive studies on the nutritional status of affected children. The aim of this study was to compare vitamin B12 levels in children with recently diagnosed food allergies and healthy children ages 0 to 36 mo. METHODS A retrospective study at Başkent University Hospital analyzed 773 patients ages 0 to 36 mo. Participants were divided into two groups: food allergy and healthy. Vitamin B12 deficiency (<300 ng/mL) was assessed using χ2 tests and regression analyses. RESULTS The sample comprised 773 children ages 0 to 36 mo, with a mean age of 16 ± 9 mo (range: 1-36). Among the participants, 399 (52%) were healthy children, whereas 374 (48%) had food allergies. The prevalence of vitamin B12 deficiency was higher in children with food allergies (38%) than in healthy children (21%; P < 0.001). According to both univariate and multivariate regression analyses, formula feeding showed a negative association with vitamin B12 deficiency (β = -0.54; 95% confidence interval [CI], 0.35-0.97; P = 0.038). On the other hand, having allergic diseases (β = 0.69; 95% CI, 0.30-0.83; P = 0.040) and breastfeeding for <6 mo (β = 1.35; 95% CI, 1.41-10.50-0.50; P = 0.009) exhibited a positive association with vitamin B12 deficiency. CONCLUSION Food-allergic children ages 0 to 36 mo were at higher risk for vitamin B12 deficiency. Formula feeding had a protective effect, whereas allergic diseases and breastfeeding for <6 mo were risk factors. Further investigation is needed to understand the underlying mechanisms. Monitoring B12 levels and interventions are crucial for the nutritional well-being of food-allergic children.
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Affiliation(s)
- Betul Orhan Kiliç
- Baskent University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey.
| | - Serhat Kiliç
- Baskent University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Enis Özmert
- Baskent University Faculty of Medicine, Medical Student, Ankara, Turkey
| | - Alara Tavares
- Baskent University Faculty of Medicine, Medical Student, Ankara, Turkey
| | - Dilek Konuksever
- Ankara Bilkent City Hospital, Department of Pediatrics, Ankara, Turkey
| | - Gözde Kubat
- Baskent University Faculty of Medicine, Department of Medical Education, Ankara, Turkey
| | - Burcu Tahire Köksal
- Baskent University Faculty of Medicine, Department of Pediatric Allergy, Ankara, Turkey
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12
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Liu L, Zhou J, Chen C, Qu Y, Wang J, Lu F, Liu Y, Cai J, Ji S, Li Y, Gu H, Zhao F, Lyu Y, Shi X. Vitamin B 12 is associated negatively with anemia in older Chinese adults with a low dietary diversity level: evidence from the Healthy Ageing and Biomarkers Cohort Study (HABCS). BMC Geriatr 2024; 24:18. [PMID: 38178043 PMCID: PMC10768404 DOI: 10.1186/s12877-023-04586-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE The associations between plasma vitamin B12 level and anemia under different dietary patterns in elderly Chinese people are poorly understood. We aimed to examine the associations between plasma vitamin B12 levels and anemia under different dietary patterns in adults aged 65 years and older in nine longevity areas in China. METHODS A total of 2405 older adults completed a food frequency questionnaire at the same time as a face-to-face interview. The dietary diversity score (DDS) was assessed based on the food frequency questionnaire, with the low DDS group referring to participants with a DDS score ≤ 4 points. Vitamin B12 levels were divided into two groups of high (>295 pg/mL) and low (≤ 295 pg/mL) with the median used as the cut-off point. Sub-analyses were also performed on older adults divided into tertiles of vitamin B12 levels: low (< 277 pg/mL), medium (277-375 pg/mL) and high (> 375 pg/mL) to study the association of these levels with anemia. RESULTS Six hundred ninety-five (28.89%) of these people were diagnosed with anemia and had a mean age of 89.3 years. Higher vitamin B12 levels were associated with a decreased risk of anemia (multi-adjusted OR, 0.59, [95% CI, 0.45 ~ 0.77] P < 0.001) in older adults with a low DDS, whereas no significant association between vitamin B12 levels and anemia was found in older adults with a high DDS in a full-model after adjustment for various confounding factors (multi-adjusted OR, 0.88, [95% CI, 0.65 ~ 1.19], P = 0.41). CONCLUSION The relationship between vitamin B12 levels and the prevalence of anemia was significant only when the level of dietary diversity in the older adults was relatively low. The dietary structure of the population should be taken into consideration in combination in order to effectively improve anemia status by supplementing vitamin B12.
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Affiliation(s)
- Ling Liu
- Hospital of Beijing Forestry University, Beijing, 100083, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Chen Chen
- Beijing Municipal Health Commission Information Center, Beijing Municipal Health Commission Policy Research Center, Beijing, 100034, China
| | - Yingli Qu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, Beijing Municipal Health Commission Policy Research Center, Beijing, 100034, China
| | - Yingchun Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Jiayi Cai
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Saisai Ji
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Yawei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Heng Gu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Feng Zhao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Yuebin Lyu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China.
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China.
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Luo X, Wang J, Lin Z, Zhao J, Cao K, Liu J. Megaloblastic anemia and benign proteinuria: Clues to the diagnosis of Imerslund-Gräsbeck syndrome. Pediatr Blood Cancer 2024; 71:e30731. [PMID: 37855200 DOI: 10.1002/pbc.30731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Xiaojuan Luo
- Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jieying Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhenhu Lin
- Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jiwei Zhao
- Department of Laboratory Medicine, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Ke Cao
- Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jinlin Liu
- Department of Clinical Laboratory, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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Guillerme J, Feugray G, Girot H, Brunel V, Muraine MQ. Preliminary evaluation of the diagnostic performance of Roche Elecsys® active vitamin B12 versus total vitamin B12 for vitamin B12 deficiency screening. Ann Clin Biochem 2024; 61:55-62. [PMID: 37503639 DOI: 10.1177/00045632231194157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The prevalence of vitamin B12 deficiency is high in at-risk populations with sometimes irreversible consequences. Beside total B12 (TVB12), active B12 (AVB12) is a promising first-line marker. Only Abbott AVB12 assays were largely evaluated and generally demonstrated benefit in clinical practice. More recently developed Roche AVB12 still requires some investigations. OBJECTIVES Our study aimed to evaluate the Roche Elecsys® AVB12 immunoassay performance versus Roche Elecsys® TVB12 competition assay. DESIGN and Methods: We included 175 patients at Rouen University Hospital who had a TVB12 value <300 pmol/L. We evaluated performance of AVB12 by comparing the results with TVB12 and MMA values in case of disagreement. RESULTS Positive correlation was found between the AVB12 and TVB12. We found a disagreement between TVB12 and AVB12 in 18.8% of cases. Among 33 cases of disagreement, 76% had normal AVB12 but low TVB12, whereas 24% had low AVB12 and normal TVB12. Thirty-one MMA determinations were performed: 71% showed agreement between MMA and AVB12, versus 29% between MMA and TVB12. TVB12 reported a sensitivity (Se) at 66.7%, specificity (Sp) at 20%, positive predictive value (PPV) at 16.7% and negative predictive value (NPV) at 71.4% for the prediction of MMA elevation. We determined an optimized cut-off value of 45.5 pmol/L for AVB12, which reported a Se 66.7%, Sp 60%, PPV 30.7%, and NPV 88.9%. CONCLUSIONS Our results provide preliminary evidence that Roche AVB12 may offer better discrimination than Roche TVB12 in the diagnosis of vitamin B12 deficiency. Further more detailed evaluation is warranted.
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Affiliation(s)
- Jennifer Guillerme
- Department of General Biochemistry, Rouen University Hospital, Rouen, France
| | - Guillaume Feugray
- Department of General Biochemistry, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, F-76000 Rouen, France
| | - Hélène Girot
- Department of General Biochemistry, Rouen University Hospital, Rouen, France
| | - Valéry Brunel
- Department of General Biochemistry, Rouen University Hospital, Rouen, France
| | - Muriel Quillard Muraine
- Department of General Biochemistry, Rouen University Hospital, F-76000 Rouen, CIC-CRB, INSERM U1404, F-76000 Rouen and Normandie UNIV, UNIROUEN, INSERMU1073 ADEN
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15
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Letete N, Vaz D, Malishi PH, Pogieter JJ, Rheeder P. Recurrent venous thrombosis - an unusual first presentation of autoimmune polyendocrinopathy syndrome type 3B. S Afr Med J 2023; 114:17-21. [PMID: 38525624 DOI: 10.7196/samj.2024.v114i1.1477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 03/26/2024] Open
Abstract
A 45-year-old female presented with unprovoked recurrent venous thromboembolism (VTE), in unusual sites, and pancytopenia, posing a complex diagnostic challenge. Work-up for inherited thrombophilia, antiphospholipid syndrome (APLS) and paroxysmal nocturnal haemoglobinuria were unremarkable. Investigations revealed autoimmune thyroid disease, and a mixed iron/vitamin B12 deficiency due to pernicious anaemia and resultant atrophic gastritis. Hyperhomocysteinaemia due to vitamin B12 deficiency was identified as a potential contributor to her recurrent VTE. This case highlights the unusual initial presentation of autoimmune polyendocrinopathy syndrome type 3B (APS-3B) with recurrent thromboembolism, and emphasises the importance of considering hyperhomocysteinaemia in unprovoked and atypical VTE cases.
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Affiliation(s)
- N Letete
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa.
| | - D Vaz
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa; Department of Haematology, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, South Africa.
| | - P H Malishi
- Department of Internal Medicine, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, South Africa.
| | - J J Pogieter
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa; Department of Haematology, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, South Africa.
| | - P Rheeder
- Department of Internal Medicine, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, South Africa.
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Bekerman VP, Berman E, You B, Turbin R, Frohman L. A Novel Mitochondrial Mutation for Lebers Hereditary Optic Neuropathy Presenting With Vitamin B12 Deficiency. J Neuroophthalmol 2023; 43:e136-e138. [PMID: 34417767 DOI: 10.1097/wno.0000000000001391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vladislav P Bekerman
- Department of Ophthalmology and Visual Science (VPB, RT, LF), Rutgers-New Jersey Medical School, Newark, New Jersey; Storm Eye Institute (EB), Medical University of South Carolina, Charleston, South Carolina; and Departments of Genetics (BY) and Neurosciences (RT, LF), Rutgers-New Jersey Medical School, Newark, New Jersey
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Walters H. Vitamin B 12 boosts cellular reprogramming. Nat Aging 2023; 3:1470. [PMID: 38052932 DOI: 10.1038/s43587-023-00546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
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18
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Gardin TM, Yang A, Moeller JJ, Quraishi IH. Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis. BMJ Case Rep 2023; 16:e254727. [PMID: 38035681 PMCID: PMC10689362 DOI: 10.1136/bcr-2023-254727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/02/2023] Open
Abstract
Nitrous oxide is among the most common drugs used by adolescents and young adults, and its neuropsychiatric sequelae are severe but reversible with timely treatment. The causal mechanism relates to impaired metabolism of vitamin B12, which is necessary for the development and maintenance of the myelin sheath. Individuals most susceptible to neuropsychiatric manifestations are those with a secondary cause of vitamin B12 deficiency, including nutritional deficiency and impaired absorption, or an alternative cause of impaired metaboclism. We describe the case of a man in his thirties who developed subacute combined degeneration of the spinal cord and polyneuropathy in the setting of recreational nitrous oxide use and autoimmune atrophic gastritis. Our case highlights clinical pearls for diagnosis and treatment, differential diagnosis, common concomitant aetiologies and the importance of screening for substance use disorder and psychiatric comorbidities.
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Affiliation(s)
| | - Annie Yang
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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19
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Guo J, Liu X, Wang Z, Lu R, Liu Y, Zhang Y, Tian W, Fang S, Wang S, Yu B. Methylmalonic acid, vitamin B12, and mortality risk in patients with preexisting coronary heart disease: a prospective cohort study. Nutr J 2023; 22:63. [PMID: 38017447 PMCID: PMC10685606 DOI: 10.1186/s12937-023-00900-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The inconsistent relationship between Vitamin B12 (B12), methylmalonic acid (MMA, marker of B12 deficiency) and mortality was poorly understood, especially in patients with coronary heart disease (CHD). This study aims to investigate the association of serum MMA, and B12-related biomarkers (serum level, dietary intake, supplement use, and sensibility to B12) with all-cause and cardiovascular mortality in adults with CHD. METHODS The data of this study were from a subcohort within the US National Health and Nutrition Examination Survey (NHANES). We included adults with preexisting CHD with serum MMA and B12, and dietary B12 intake measurements at recruitment. All participants were followed up until 31 December 2019. Weighted Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% CI of mortality risk. RESULTS Overall, 1755 individuals (weighted mean [SE] age, 65.2 [0.5] years; 1047 men [weighted 58.5%]) with CHD were included, with geometric mean levels of serum MMA 182.4 nmol/L, serum B12 494.5 pg/ml, and dietary B12 intake 4.42 mg/day, and percentage of B12 supplements use 39.1%. During a median follow-up of 7.92 years, 980 patients died. Serum B12 concentration, dietary B12 intake and supplements use were not significantly associated with mortality risk (each p ≥ 0.388). In contrast, individuals in the top tertile of MMA had multivariable-adjusted HRs (95% CIs) of 1.70 (1.31-2.20) for all-cause mortality, and 2.00 (1.39-2.89) for cardiovascular mortality (both p trend < 0.001) compared to those in the bottom tertile of MMA. MMA-related mortality risk was particularly higher among participants with sufficient serum B12 (p < 0.001). CHD patients with increased levels of both MMA and B12 had a doubled mortality risk compared to those with lower MMA and B12 (p < 0.001). CONCLUSION MMA accumulation but not serum or dietary vitamin B12 was associated with increased cardiovascular mortality risk among patients with CHD. This paradox may be related to decreased response to vitamin B12.
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Affiliation(s)
- Junchen Guo
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China
| | - XiaoXuan Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China
| | - Zeng Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China
| | - Rongzhe Lu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China
| | - Yige Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China
| | - Yiying Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, 154000, China
| | - Wei Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150000, China
| | - Shaohong Fang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China
| | - Shanjie Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China.
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China.
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150000, China.
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150000, China.
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Affiliation(s)
| | - P Julian Owen
- Department of Trauma and Orthopaedics, Addenbrooke's, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, USA
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Kerlikowsky F, Schuchardt JP, Hahn A. Folate, vitamin B12 and vitamin D status in healthy and active home-dwelling people over 70 years. BMC Geriatr 2023; 23:673. [PMID: 37853337 PMCID: PMC10585793 DOI: 10.1186/s12877-023-04391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Ageing is characterised by physiological changes that can affect the nutrient availability and requirements. In particular, the status of vitamin D, cobalamin and folate has often been found to be critical in older people living in residential care. However, there is a lack of studies investigating the status of these nutrients in healthy and active home-dwelling elderly people. METHODS The aim of this cross-sectional study was to assess the status of vitamin D based on serum concentrations of 25-hydroxycholecalciferol [25-(OH)D], cobalamin based on serum concentrations of holotranscobalamin (holoTC) and folate based on red blood cell (RBC) folate in unsupplemented, healthy and active German home-dwelling subjects ≥ 70 years of age (n = 134, mean ± SD: 75.8 ± 4.5 years). Dietary intake was assessed by 3-day food recalls. The study was conducted between March and November of 2021 (during the COVID-19 pandemic). RESULTS The mean 25-(OH)D concentration was high at 85.1 ± 26.0 nmol/L, while the majority of women (92%) and men (94%) had 25-(OH)D concentrations ≥ 50 nmol/L. Less than 10% of men and women had 25-(OH)D concentrations < 50 nmol/L. The mean holoTC concentration was 88.9 ± 33.7 pmol/L (94.8 ± 34.6 pmol/L in women and 73.6 ± 25.6 in men). Only 8% of the women were cobalamin deficient (< 50 pmol/L holoTC) compared to 22% of the men. The mean RBC folate concentration was 831 ± 244 nmol/L, while the prevalence of folate deficiency was 10%. Linear regression analysis showed that only folate equivalent intake was associated with the relevant nutrient status marker. CONCLUSION Our findings suggest that healthy, independently living older people with high levels of education, physical activity, and health awareness are not necessarily at higher risk of vitamin D, folate and cobalamin deficiency. Further studies are needed to verify these findings and to identify lifestyle and dietary patterns that can predict adequate nutrient status for healthy ageing. TRIAL REGISTRATION This study is officially recorded in the German Clinical Trials Register (DRKS00021302).
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Affiliation(s)
- Felix Kerlikowsky
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Jan Philipp Schuchardt
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany.
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McKee A, Salter B, Mithoowani S. Severe vitamin B 12 deficiency causing pseudo-thrombotic microangiopathy. CMAJ 2023; 195:E1300-E1304. [PMID: 37788842 PMCID: PMC10637334 DOI: 10.1503/cmaj.230959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Aidan McKee
- Department of Medicine (McKee), Western University, London, Ont.; Department of Medicine (Salter, Mithoowani), McMaster University, Hamilton, Ont
| | - Brittany Salter
- Department of Medicine (McKee), Western University, London, Ont.; Department of Medicine (Salter, Mithoowani), McMaster University, Hamilton, Ont
| | - Siraj Mithoowani
- Department of Medicine (McKee), Western University, London, Ont.; Department of Medicine (Salter, Mithoowani), McMaster University, Hamilton, Ont.
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23
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Bennani H, Ouarradi AE, Lazrek H, Yahyaoui H, Chakour M. A New Case of Association of Megaloblastic Anemia and Pancytopenia of Infants. Clin Lab 2023; 69. [PMID: 37844051 DOI: 10.7754/clin.lab.2023.230420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Vitamin B12, or cobalamin deficiency, an infrequent clinical entity in pediatric age, is found almost solely in breastfed infants whose mothers are purely vegetarian, non-supplemented or with pernicious anemia. Megaloblastic anemia in infants presents with generalized weakness or irritability. METHODS Diagnosis is usually centered on complete blood count, vitamin dosing, and peripheral smear, which may show macrocytes, hypersegmented neutrophils, reticulocytopenia and a raised mean corpuscular volume (MCV ˃ 100 fL). Pancytopenia has also been noted. RESULTS We report an exclusive breastfed nine-month-old female child who presented with irritability, developmental delay, and difficulties in introducing new foods. Her initial blood count revealed pancytopenia. Vitamin B12 levels were found to be reduced. Maternal levels of Vitamin B12 were also found to be borderline low. The child was treated as per protocols, and improvement was evidenced with the return of hematological parameters to the regular and gradual advancement of milestones. CONCLUSIONS We aim to underscore the importance of megaloblastic anemia as an important and rare cause of anemia in infancy.
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Jin HY, Lee KA, Kim YJ, Gwak IS, Park TS, Yeom SW, Kim JS. Bidirectional association between diabetic peripheral neuropathy and vitamin B12 deficiency: Two longitudinal 9-year follow-up studies using a national sample cohort. Prim Care Diabetes 2023; 17:436-443. [PMID: 37344286 DOI: 10.1016/j.pcd.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
AIM This study aims to investigate the association among metformin use, vit B12 deficiency, and DPN occurrence in diabetes. METHODS This retrospective, propensity-matched cohort study was performed using National Health Insurance Service database - National Sample Cohort in South Korea. Study 1 analyzed DPN incidence according to vit B12 deficiency and study 2 analyzed vit B12 deficiency incidence according to the presence/absence of DPN. Moreover, we compared the results with respect to metformin use. RESULTS In study 1, DPN incidence per 10000 person-year (PY) was 179.7 and 76.6 in the vit B12 and non-vit B12 deficiency groups, respectively. The adjusted HR was 1.32 (95% CI; 1.21-1.44, P < 0.05) and metformin use elicited a more significant effect of DPN occurrence in patient with vit B12 deficiency (HR: 5.76 (95% CI; 5.28-6.29). In study 2, vit B12 deficiency incidence per 10000 PY was 250.6 and 129.4 in the DPN and non-DPN groups, respectively. The adjusted HR was 2.44 (95% CI; 2.24-2.66, P < 0.05), however, metformin prescription was associated with the reduced incidence of vit B12 deficiency in DPN patients (HR 0.68 (95% CI; 0.62-0.74, P < 0.05). CONCLUSION DPN occurrence increased in diabetes with vit B12 deficiency and the incidence of vit B12 deficiency was also high in DPN patients. However, metformin showed opposite effects in both cohorts. Further studies clarifying the causal relationship among DPN occurrence, vit B12 deficiency, and metformin use are warranted.
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Affiliation(s)
- Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Yu Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - In Sun Gwak
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Sang Woo Yeom
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Medical Informatics, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Jong Seung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Medical Informatics, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
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Nanjiani D, Kumar S, Sharma N, Nasim S, Azim D, Parkash O. Congenital thrombotic thrombocytopenic purpura masquerading as vitamin B12 deficiency. Transfus Apher Sci 2023; 62:103728. [PMID: 37244785 DOI: 10.1016/j.transci.2023.103728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Congenital thrombotic thrombocytopenic purpura (CTTP), also called Upshaw-Schulman syndrome (USS), is a rare autosomal recessive disorder resulting from the deficiency of the ADAMTS13. CTTP is characterized by the formation of platelet-rich thrombi in small vessels of multiple organs, resulting in thrombocytopenia and microangiopathic hemolytic anemia, eventually leading to organ failure. CASE REPORT We present a case of an 11-month-old male infant with CTTP lacking classic features of the disease. Instead, his clinical picture portrayed vitamin B12 deficiency, leading to misdiagnosis and subsequent treatment delay. CONCLUSION This case led to the conclusion that congenital TTP should be suspected in case of vitamin B12 deficiency if the child does not respond to the vitamin B12 replacement therapy. We also emphasize that management for CTTP should be started at its earliest in case of increased clinical suspicion to avoid worse outcomes, especially in countries lacking rapid availability of enzyme assay.
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Affiliation(s)
- Deedar Nanjiani
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Sohail Kumar
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan.
| | - Nitik Sharma
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Sundus Nasim
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Dua Azim
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Oam Parkash
- Pediatric Department, Dr. Ruth K. M. Pfau Civil Hospital, Karachi 74200, Pakistan
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Yıldız O, Erdem Tilki H. Visual Evoked Potentials in Patients With Vitamin B12 Deficiency. J Clin Neurophysiol 2023; 40:535-540. [PMID: 35349545 DOI: 10.1097/wnp.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the subclinical involvement of the optic nerve in asymptomatic patients with vitamin B12 deficiency using visual evoked potentials. METHODS This study included 40 asymptomatic patients diagnosed with vitamin B12 deficiency (considered as serum levels below 150 pg/mL) and a control group of 40 healthy individuals. All participants underwent a visual evoked potential examination. Routine screening for homocysteine was performed for patients with vitamin B12 deficiency. The levels of vitamin B12 and homocysteine and the presence of megaloblastic anemia were analyzed statistically compared with P100, N75, and N135 latencies and amplitudes. RESULTS The mean vitamin B12 level was 96 pg/mL in the patient group and 374 pg/mL in the control group. In the patient group, 24 (60%) patients had hyperhomocysteinemia and 8 (20%) patients had megaloblastic anemia. The P100 wave latency of patients with vitamin B12 deficiency was significantly prolonged compared with the control group ( P < 0.01). There was no significant difference in the P100 amplitude between the patient group and the control group. P100 latencies were significantly longer in patients with hyperhomocysteinemia ( P = 0.002). CONCLUSIONS Our study showed that patients with vitamin B12 deficiency may have visual evoked potential abnormalities without visual symptoms or examination findings. In addition, high homocysteine levels led to a prolonged P100 latency in the patient group independent of vitamin B12 levels.
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Affiliation(s)
- Onur Yıldız
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Abosamra M, Bateman AC, Jalal M. Chronic atrophic gastritis - An overlooked association with severe vitamin B12 deficiency: A case report and rapid review of literature. J R Coll Physicians Edinb 2023; 53:176-178. [PMID: 37329268 DOI: 10.1177/14782715231180965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023] Open
Abstract
Current guidelines recommend surveillance for gastric adenocarcinoma in patients with extensive chronic atrophic gastritis (CAG), which is considered a premalignant condition. Although the association between vitamin B12 deficiency and CAG is well described, the indication for endoscopic investigation is only advised in patients with pernicious anaemia. Our case did not have evidence of autoimmune or H. pylori infection but despite this she had CAG. We suggest considering gastroscopy for severe, unexplained vitamin B12 deficiency, particularly in this patient group.
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Affiliation(s)
- Mahmoud Abosamra
- Department of Gastroenterology, Southampton General Hospital, Southampton, UK
- Department of Medicine, Hull University Teaching Hospitals, Hull, UK
| | - Adrian C Bateman
- Department of Gastroenterology, Southampton General Hospital, Southampton, UK
- Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
| | - Mustafa Jalal
- Department of Gastroenterology, Southampton General Hospital, Southampton, UK
- Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, UK
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Mondesert E, Eiden C, Peyriere H, Formoso A, Corti L, Cristol JP, Badiou S. Functional vitamin B 12 deficiency is a consistent feature in hospital admissions for neurological disorders due to the use of nitrous oxide. Clin Toxicol (Phila) 2023; 61:674-679. [PMID: 37917184 DOI: 10.1080/15563650.2023.2274282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
Introduction: Misuse of inhaled nitrous oxide is a growing concern in France. It is known to alter concentrations of vitamin B12, which is required as a cofactor for methionine synthase and methylmalonyl-CoA mutase activity. Hence, measurement of the concentrations of cobalamin metabolism biomarkers, including vitamin B12, homocysteine, and methylmalonic acid, could assist in the management of patients with a complex clinical presentation or in those who deny the consumption of nitrous oxide.Methods: We retrospectively collected clinical and biological data in patients hospitalized for nitrous oxide use in a university hospital in southern France between January 2020 and October 2022.Results: Thirty-one patients were identified during 34 months; 79% were men with a median age of 23.7 years. Most (97%) presented with peripheral polyneuropathy and/or myelopathy. The median vitamin B12 concentration was 134.6 pmol/L, with 17 of 31 patients having values less than 145 pmol/L (the lower limit of the normal range). The median plasma folate concentration was 20.1 nmol/L, which is within the normal range. The median plasma homocysteine concentration was 87.7 µmol/L (normal range <15 µmol/L), and the median plasma methylmalonic acid concentration was 3.8 µmol/L (normal range <0.5 µmol/L).Conclusion: Nitrous oxide use is an emerging public health problem in France, as shown by the number of patients admitted to our hospital. The presence of a functional vitamin B12 deficiency was a consistent feature that could be helpful in diagnosis in complex cases.
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Affiliation(s)
- Etienne Mondesert
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
| | - Céline Eiden
- Addictovigilance Center, Department of Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Hélène Peyriere
- Addictovigilance Center, Department of Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Aude Formoso
- Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Lucas Corti
- Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
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Krishna G, Singh M, Gill BS, Kumar V, Aggarwal VK, Singh I. Bilateral sixth nerve palsy with subdural hematoma: a unique presentation of B12 deficiency. Childs Nerv Syst 2023; 39:2533-2536. [PMID: 37209197 DOI: 10.1007/s00381-023-05996-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
Vitamin B12 is inextricably associated with the development and maintenance of neuronal functions. It is classically associated with subacute combined degeneration and peripheral neuropathy; however, cranial neuropathy is uncommon. We observed the rarest neurological manifestation of B12 deficiency. A 12 months infant had history of lethargy, irritability, anorexia, paleness, vomiting, and neurodevelopmental delay for 2 months. He also developed inattention and altered sleep pattern. His mother noticed bilateral inward rotation of both eyes. On examination, the infant had bilateral lateral rectus palsy. The infant was found to have anemia (7.7g/dL) and severe B12 deficiency (74pg/mL). On MRI, there was cerebral atrophy, subdural hematoma (SDH) and wide cisternal spaces and sulci. On supplementation with cobalamin, he improved clinically though mild restriction of lateral gaze on the left side persists. Follow up MRI showed significant improvement in cerebral atrophy with resolution of SDH. To date, such clinical presentation of B12 deficiency has never been reported. The authors suggest B12 supplementation for at risk population esp at antenatal stage and lactating mothers in national programs. The treatment of this condition should be initiated early to prevent long term sequelae.
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Affiliation(s)
- Gopal Krishna
- Pt B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India.
| | - Manjeet Singh
- Pt B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Bikrampreet Singh Gill
- Pt B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Vivek Kumar
- Pt B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Varun Kumar Aggarwal
- Pt B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Ishwar Singh
- Pt B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
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Schnabel E, Kölker S, Gleich F, Feyh P, Hörster F, Haas D, Fang-Hoffmann J, Morath M, Gramer G, Röschinger W, Garbade SF, Hoffmann GF, Okun JG, Mütze U. Combined Newborn Screening Allows Comprehensive Identification also of Attenuated Phenotypes for Methylmalonic Acidurias and Homocystinuria. Nutrients 2023; 15:3355. [PMID: 37571294 PMCID: PMC10420807 DOI: 10.3390/nu15153355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Newborn screening (NBS) programs are effective measures of secondary prevention and have been successively extended. We aimed to evaluate NBS for methylmalonic acidurias, propionic acidemia, homocystinuria, remethylation disorders and neonatal vitamin B12 deficiency, and report on the identification of cofactor-responsive disease variants. This evaluation of the previously established combined multiple-tier NBS algorithm is part of the prospective pilot study "NGS2025" from August 2016 to September 2022. In 548,707 newborns, the combined algorithm was applied and led to positive NBS results in 458 of them. Overall, 166 newborns (prevalence 1: 3305) were confirmed (positive predictive value: 0.36); specifically, methylmalonic acidurias (N = 5), propionic acidemia (N = 4), remethylation disorders (N = 4), cystathionine beta-synthase (CBS) deficiency (N = 1) and neonatal vitamin B12 deficiency (N = 153). The majority of the identified newborns were asymptomatic at the time of the first NBS report (total: 161/166, inherited metabolic diseases: 9/14, vitamin B12 deficiency: 153/153). Three individuals were cofactor-responsive (methylmalonic acidurias: 2, CBS deficiency: 1), and could be treated by vitamin B12, vitamin B6 respectively, only. In conclusion, the combined NBS algorithm is technically feasible, allows the identification of attenuated and severe disease courses and can be considered to be evaluated for inclusion in national NBS panels.
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Affiliation(s)
- Elena Schnabel
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Stefan Kölker
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Florian Gleich
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Patrik Feyh
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Friederike Hörster
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Dorothea Haas
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Junmin Fang-Hoffmann
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Marina Morath
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Gwendolyn Gramer
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
- Department for Inborn Metabolic Diseases, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Wulf Röschinger
- Labor Becker MVZ GbR, Newborn Screening Unit, 81671 Munich, Germany
| | - Sven F. Garbade
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Georg F. Hoffmann
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Jürgen G. Okun
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
| | - Ulrike Mütze
- Division of Child Neurology and Metabolic Medicine, Dietmar Hopp Metabolic Center, Center for Child and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.S.); (J.G.O.)
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Michalak SS, Sterna W. Coexistence and clinical implications of anemia and depression in the elderly population. Psychiatr Pol 2023; 57:517-528. [PMID: 38043070 DOI: 10.12740/pp/147079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Anemia and depression are common in the elderly and they are important medical, social and economic problems for the world. Both disorders are associated with a lower quality of life, multimorbidity and a higher risk of death. The connections between anemia and depression have been reported, but the mechanism and clinical consequences of their co-existence are not fully understood. Several links can be found between anemia and depression in the elderly: common etiological factors, low socioeconomic status of patients, poor education and less physical activity. Both conditions are associated with the occurrence of the same pathological changes: age-related (especially with the presence of inflammation, oxidative stress, degenerative changes in organs and tissues), nutritional deficiencies (iron, vitamin B12, folic acid) and hormonal disorders (especially thyroid gland disorders, sex hormone deficiencies). Anemia and depression are not sufficiently diagnosed in the elderly and, as a result, are often left untreated. The diagnosis and treatments of these conditions in the elderly differ from those in other age groups. The study provides an overview of the literature regarding the co-existence of anemia and depression in elderly patients and clinical recommendations.
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Affiliation(s)
| | - Władysław Sterna
- Katedra Psychiatrii, Collegium Medicum Uniwersytetu Zielonogórskiego
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Bari BA, Ivkovic A, Wininger BA. Mild Vitamin C Deficiency Is Common in the Inpatient Psychiatric Setting. J Clin Psychiatry 2023; 84:22m14616. [PMID: 37339367 PMCID: PMC10428288 DOI: 10.4088/jcp.22m14616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Objective: Mild vitamin C deficiency is a psychiatrically relevant nutritional state, with symptoms including apathy, fatigue, and low mood. Although complete vitamin C deficiency has largely been eradicated, mild deficiency remains common in certain populations. Here, we aimed to identify the prevalence of mild vitamin C deficiency in the inpatient psychiatric setting. Methods: We identified 221 patients with plasma vitamin C levels collected on an inpatient psychiatric unit serving a metropolitan area between January 1, 2015, and March 7, 2022. We identified demographic (age, sex, race, housing status, Area Deprivation Index [an index of neighborhood disadvantage]), substance use (tobacco use, alcohol use), diagnostic (depressive, bipolar, psychotic, anxiety, substance use, catatonia, neurocognitive, autism spectrum), and micronutrient (folate, vitamin B12, vitamin D) risk factors. DSM-5-TR was used as the diagnostic system. Bayesian log-normal regressions were constructed to predict vitamin C as a function of these risk factors. We used these same models to predict vitamin C as a function of significant risk factors. Results: We found that 64% (141 of 221; 95% confidence interval 57%-70%) of patients met criteria for mild vitamin C deficiency. While we did not identify robust demographic, substance use, or diagnostic-based risk factors, we found that folate and vitamin D strongly predicted vitamin C levels. To test the utility of these predictors, we simulated vitamin C as a function of folate and vitamin D and found that predicted deficiency remained high (∼ 50%-55%), even when folate/vitamin D were sufficiently replete. Conclusions: We find that vitamin C deficiency is highly prevalent in the inpatient psychiatric setting and remains high even when the relevant risk factor profile is favorable.
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Affiliation(s)
- Bilal A Bari
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Corresponding Author: 15 Parkman St, WACC 812, Boston, MA 02114
| | - Ana Ivkovic
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Bryce A Wininger
- Department of Psychiatry, Massachusetts General Hospital, Boston
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33
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Alhujaili NA. Catatonia and vitamin B12 deficiency - A hidden cause? A review article. Eur Rev Med Pharmacol Sci 2023; 27:3294-3299. [PMID: 37140279 DOI: 10.26355/eurrev_202304_32100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This paper aims to broadly overview catatonia and vitamin B12 deficiency and highlight this association as a possible hidden cause. A review of published articles which examined the association between vitamin B12 deficiency and catatonia was performed. The articles for this review were selected by searching the electronic databases of the MEDLINE from March 2022 until August 2022 using catatonia (and related terms such as psychosis; psychomotor) and vitamin B12 (and related terms such as vitamin B12 deficiency; neuropsychiatry) as keywords. Articles had to be written in English to be included in this review. The direct relationship between levels of B12 and catatonic symptoms is difficult to confirm, as catatonia has different etiologies and can be triggered under the influence of multifactorial stressors. In this review, few published reports showed the reversibility of the catatonic symptoms once the level of B12 levels increased to more than 200 pg/ml. This could explain the responsibility of deficiency of B12 in the catatonic presentation of the few published case reports. B12-level screening in cases of catatonia of unclear etiology needs to be considered, particularly in a group at risk of B12 deficiency. Of particular concern is that vitamin B12 can be close to the normal range, which may delay the diagnosis. Detection and treatment of catatonic illness usually result in a rapid resolution of the condition, which, if untreated, can lead to potentially fatal outcomes.
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Affiliation(s)
- N A Alhujaili
- Department of Medicine, Division of Psychiatry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
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34
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Grzych G, Deheul S, Gernez E, Davion JB, Dobbelaere D, Carton L, Kim I, Guichard JC, Girot M, Humbert L, Bennis A, Joncquel M, Chieux V, Joly A, Nasserdine P, Trillot N, Douillard C, Pigny P, Tard C. Comparison of biomarker for diagnosis of nitrous oxide abuse: challenge of cobalamin metabolic parameters, a retrospective study. J Neurol 2023; 270:2237-2245. [PMID: 36690804 DOI: 10.1007/s00415-023-11570-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recreational use of nitrous oxide (N2O) leads to neurological disorders including combined subacute degeneration of spinal cord, psychological disorders, and thrombosis. Serum or urine N2O assays could not be routinely performed. Hence, it is necessary to investigate other biological markers such as metabolic markers. We aimed here to challenge the three main biological markers used for the diagnosis of nitrous oxide abuse as total vitamin B12, homocysteine, and methylmalonic acid. METHODS We retrospectively collected clinical and biological data from 52 patients with known, documented chronic N2O abuse and associated clinical signs (peripheral neuropathy disability score or thrombosis event). Sera and plasma total vitamin B12, methylmalonic acid (MMA), and homocysteine were performed to identify the most specific marker of chronic N2O intoxication and related clinical outcomes. RESULTS Plasma homocysteine was almost consistently increased in case of N2O chronic consumption, whereas MMA increase and total vitamin B12 decrease are not systematically found. Our results showed that none of the markers are correlated with levels of N2O consumptions. However, homocysteine and MMA are correlated with clinical severity, but MMA seems to be a better marker of clinical severity. CONCLUSION There is no specific marker of nitrous oxide abuse according to levels of consumption, total vitamin B12 decrease could not be used either as consumption or as severity marker. However, we showed that homocysteine is consistently increased and could be used as marker of recent N2O consumption. On the other hand, we showed that MMA could be used as a marker of clinical gravity.
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Affiliation(s)
- Guillaume Grzych
- CHU de Lille, Service Hormonologie Métabolisme Nutrition Oncologie, 59000, Lille, France.
- CHU de Lille - Centre de Biologie Pathologie Génétique - Service Hormonologie Métabolisme Nutrition Oncologie, 1 boulevard du professeur Jules Leclercq, 59000, Lille, France.
| | - Sylvie Deheul
- CHU de Lille, Centre d'Addictovigilance des Hauts-de-France, Centre Anti-Poison, Service de Pharmacologie, 59000, Lille, France
| | - Emeline Gernez
- CHU de Lille, Service Hormonologie Métabolisme Nutrition Oncologie, 59000, Lille, France
| | | | - Dries Dobbelaere
- Medical Reference Center for Inherited Metabolic Diseases, Jeanne de Flandre University Hospital and RADEME Research Team for Rare Metabolic and Developmental Diseases, EA 7364 CHU Lille, 59000, Lille, France
| | - Louise Carton
- CHU de Lille, Centre d'Addictovigilance des Hauts-de-France, Centre Anti-Poison, Service de Pharmacologie, 59000, Lille, France
- CHU de Lille, Service d'Addictologie, 59000, Lille, France
| | - Isabelle Kim
- CHU de Lille, Service Hormonologie Métabolisme Nutrition Oncologie, 59000, Lille, France
| | | | - Marie Girot
- CHU Lille, Service des Urgences adultes, F-59000, Lille, France
| | - Linda Humbert
- CHU de Lille, Service d'Endocrinologie, Diabétologie et Maladies métaboliques, 59000, Lille, France
| | - Anas Bennis
- CH de Roubaix, Service de Neurologie, 59100, Roubaix, France
| | - Marie Joncquel
- CHU de Lille, Service Hormonologie Métabolisme Nutrition Oncologie, 59000, Lille, France
| | - Vincent Chieux
- CH Saint Philibert, Laboratoire des hôpitaux du GHICL, 59160, Lomme, France
| | - Audrey Joly
- Agence Régionale de Santé Hauts de France, Amiens, France
| | - Phénicia Nasserdine
- CHU de Lille, Service d'Explorations Fonctionnelles Cardiovasculaires, 59000, Lille, France
| | - Nathalie Trillot
- CHU de Lille, Institut Hématologie Transfusion, 59000, Lille, France
| | - Claire Douillard
- Medical Reference Center for Inherited Metabolic Diseases, Jeanne de Flandre University Hospital and RADEME Research Team for Rare Metabolic and Developmental Diseases, EA 7364 CHU Lille, 59000, Lille, France
- CHU de Lille, Service d'Endocrinologie, Diabétologie et Maladies métaboliques, 59000, Lille, France
| | - Pascal Pigny
- CHU de Lille, Service Hormonologie Métabolisme Nutrition Oncologie, 59000, Lille, France
| | - Céline Tard
- U1172, CHU de Lille, Centre de référence des maladies neuromusculaires Nord, Est, Ile-de-France, Service de neurologie, Lille, France
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Goyne C, Kansal L. Pearls & Oy-sters: Late-Onset Cobalamin C Deficiency Presenting With Subacute Combined Degeneration. Neurology 2023; 100:486-489. [PMID: 36543571 PMCID: PMC9990847 DOI: 10.1212/wnl.0000000000201695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/01/2022] [Indexed: 12/24/2022] Open
Abstract
Cobalamin C (CblC) deficiency is a rare inborn error in cobalamin (vitamin B12) metabolism which results in impaired intracellular processing of dietary vitamin B12. This leads to a wide range of clinical manifestations including cognitive impairment, psychiatric symptoms, myelopathy, thrombotic events, glomerulonephritis, and pulmonary arterial hypertension. CblC deficiency typically presents in the pediatric population but can also present in adulthood. Diagnosis in adults can be challenging due to the rarity of this condition and its myriad clinical presentations. CblC deficiency is treatable, so early diagnosis is important in preventing permanent neurologic damage. Although CblC deficiency results from a defect in vitamin B12 metabolism, B12 levels remain normal. Diagnosis depends on testing metabolites altered by vitamin B12 dysfunction such as methylmalonic acid (MMA) and homocysteine. We presented a case of a 20-year-old woman who presented with chronic progressive lower extremity weakness and sensory changes. She was eventually diagnosed with subacute combined degeneration because of CblC deficiency and effectively treated. This case highlights the importance of considering inborn errors of metabolism in adult patients and including testing of metabolites such as MMA and homocysteine when suspecting vitamin B12 dysfunction.
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Bobat H, Akyol M, Moradi P. Comment on: 'Patients with unexplained neurological symptoms and signs should be screened for vitamin B12 deficiency regardless of haemoglobin levels'. Eye (Lond) 2023; 37:191-192. [PMID: 35780189 PMCID: PMC9829834 DOI: 10.1038/s41433-022-02162-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Hannaa Bobat
- Queen Alexandra Hospital, Cosham, Portsmouth, UK.
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Chandra J, Dewan P, Kumar P, Mahajan A, Singh P, Dhingra B, Radhakrishnan N, Sharma R, Manglani M, Rawat AK, Gupta P, Gomber S, Bhat S, Gaikwad P, Elizabeth KE, Bansal D, Dubey AP, Shah N, Kini P, Trehan A, Datta K, Basavraja GV, Saxena V, Kumar RR. Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics. Indian Pediatr 2022; 59:782-801. [PMID: 36263494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
JUSTIFICATION Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. OBJECTIVE To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. PROCESS These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. RECOMMENDATIONS We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.
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Affiliation(s)
- Jagdish Chandra
- Department of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi. Correspondence to: Dr Jagdish Chandra, Professor of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi.
| | - Pooja Dewan
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi
| | - Amita Mahajan
- Department of Pediatrics, Department of Pediatric Hematology and Oncology, Indraprastha Apollo Hospital, Delhi
| | - Preeti Singh
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi
| | | | - Nita Radhakrishnan
- Department of Pediatrics, Pediatric Hematology Oncology, Post Graduate Institute of Child Health. NOIDA, Uttar Pradesh
| | - Ratna Sharma
- Department of Pediatrics, MCGM- Comprehensive Thalassemia Care, Pediatric Hematology-Oncology and BMT Centre, Mumbai, Maharashtra
| | - Mamta Manglani
- Department of Pediatrics, MCGM- Comprehensive Thalassemia Care, Pediatric Hematology-Oncology and BMT Centre, Mumbai, Maharashtra
| | - Ashok Kumar Rawat
- Department of Pediatrics, PAN Society, Indian Academy of Pediatrics (IAP)
| | - Piyush Gupta
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Sunil Gomber
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Sunil Bhat
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Parag Gaikwad
- Department of Pediatrics, National Secretary - Nutrition Chapter of IAP
| | - K E Elizabeth
- Department of Pediatrics, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamilnadu
| | - Deepak Bansal
- Department of Pediatrics, Hematology-Oncology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Anand Prakash Dubey
- Department of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi
| | - Nitin Shah
- Department of Pediatrics, BJ Wadia Hospital for Children, Mumbai and PD Hinduja Hospital, Mumbai
| | - Pranoti Kini
- MCGM- Comprehensive Thalassemia Care, Pediatric Hematology-Oncology and BMT Centre, Mumbai, Maharashtra
| | - Amita Trehan
- Hematology-Oncology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Kalpana Datta
- Department of Pediatrics Medical College, Kolkata, West Bengal
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Soffer S, Efros O, Levin MA, Freeman R, Zimlichman E, Reich DL, Klang E. Low Frequency of Folate and Vitamin B12 Deficiency in Patients with Marked Macrocytic Anemia. J Gen Intern Med 2022; 37:3504-3505. [PMID: 35194742 PMCID: PMC9551153 DOI: 10.1007/s11606-022-07451-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel.
- Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Orly Efros
- Thrombosis & Hemostasis Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Matthew A Levin
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Freeman
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eyal Zimlichman
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Hospital Management, Sheba Medical Center, Tel Hashomer, Israel
- Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel
| | - David L Reich
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eyal Klang
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
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Marelli C, Fouilhoux A, Benoist J, De Lonlay P, Guffon‐Fouilhoux N, Brassier A, Cano A, Chabrol B, Pennisi A, Schiff M, Acquaviva C, Murphy E, Servais A, Lachmann R. Very long-term outcomes in 23 patients with cblA type methylmalonic acidemia. J Inherit Metab Dis 2022; 45:937-951. [PMID: 35618652 PMCID: PMC9540587 DOI: 10.1002/jimd.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To present the very long-term follow up of patients with cobalamin A (cblA) deficiency. METHODS A retrospective case series of adult (>16 years) patients with molecular or enzymatic diagnosis of cblA deficiency. RESULTS We included 23 patients (mean age: 27 ± 7.6 years; mean follow-up: 24.9 ± 7.6 years). Disease onset was mostly pediatric (78% < 1 year, median = 4 months) with acute neurologic deterioration (65%). Eight patients presented with chronic symptoms, and one had an adult-onset mild cblA deficiency. Most of the patients (61%) were initially classified as vitamin B12-unresponsive methylmalonic aciduria (MMA); in vitro B12 responsiveness was subsequently found in all the tested patients (n = 13). Initial management consisted of protein restriction (57%), B12 (17%), or both (26%). The main long-term problems were intellectual disability (39%) and renal failure (30%). However, 56.5% of the patients were living independently. Intellectual disability was equally distributed among the initial treatment groups, while renal failure (moderate and beginning at the age of 38 years) was present in only one out of seven patients initially treated with B12. CONCLUSIONS We provide a detailed picture of the long-term outcome of a series of adult cblA patients, mostly diagnosed before the enzymatic and molecular era. We confirm that about 35% of the patients do not present acutely, underlining the importance of measuring MMA in any case of unexplained chronic renal failure, intellectual disability, or growth delay. In addition, we describe a patient with a milder adult-onset form. Early B12 supplementation seems to protect from severe renal insufficiency.
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Affiliation(s)
- Cecilia Marelli
- Expert Centre for Neurogenetic Diseases and Adult Mitochondrial and Metabolic DiseasesUniversity Hospital of MontpellierMontpellierFrance
- MMDNUniversity of Montpellier, Ecole Pratique des Hautes Etudes, InsermMontpellierFrance
| | - Alain Fouilhoux
- Reference Center for Inborn Error of MetabolismHôpital Femme Mère Enfant, Hospices Civils de LyonBronFrance
| | - Jean‐Francois Benoist
- Inserm UMR_S1163Institut ImagineParisFrance
- Biochemistry DepartmentHôpital Necker Enfants Malades, Assistance Publique – Hôpitaux de ParisParisFrance
| | - Pascale De Lonlay
- Necker Hospital, Assistance Publique – Hôpitaux de Paris, Reference Center for Inborn Error of Metabolism and Filière G2M, Pediatrics DepartmentUniversity of ParisParisFrance
| | - Nathalie Guffon‐Fouilhoux
- Reference Center for Inborn Error of MetabolismHôpital Femme Mère Enfant, Hospices Civils de LyonBronFrance
| | - Anais Brassier
- Necker Hospital, Assistance Publique – Hôpitaux de Paris, Reference Center for Inborn Error of Metabolism and Filière G2M, Pediatrics DepartmentUniversity of ParisParisFrance
| | - Aline Cano
- Reference Center for Inherited Metabolic Disorders, Assistance Publique Hôpitaux de MarseilleCentre Hospitalier Universitaire de La Timone EnfantsMarseilleFrance
| | - Brigitte Chabrol
- Reference Center for Inherited Metabolic Disorders, Assistance Publique Hôpitaux de MarseilleCentre Hospitalier Universitaire de La Timone EnfantsMarseilleFrance
| | - Alessandra Pennisi
- Necker Hospital, Assistance Publique – Hôpitaux de Paris, Reference Center for Inborn Error of Metabolism and Filière G2M, Pediatrics DepartmentUniversity of ParisParisFrance
| | - Manuel Schiff
- Inserm UMR_S1163Institut ImagineParisFrance
- Necker Hospital, Assistance Publique – Hôpitaux de Paris, Reference Center for Inborn Error of Metabolism and Filière G2M, Pediatrics DepartmentUniversity of ParisParisFrance
| | - Cecile Acquaviva
- Center for Inherited Metabolic Disorders and Neonatal Screening, Est Biology and Pathology Department, Groupement Hospitalier Est (GHE)Hospices Civils de LyonBronFrance
| | - Elaine Murphy
- C. Dent Adult Metabolic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Aude Servais
- Necker Hospital, Assistance Publique – Hôpitaux de Paris, Reference Center for Inborn Error of Metabolism and Filière G2M, Pediatrics DepartmentUniversity of ParisParisFrance
- Adult Nephrology and Transplantation DepartmentHôpital Necker Enfants Malades, APHPParisFrance
| | - Robin Lachmann
- C. Dent Adult Metabolic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
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Schroeter T, Gühne F, Schwab M, Drescher R, Axer H. Differentiation of Reversible Hemichorea Due to Vitamin B12 Deficiency From Huntington Disease Via FDG PET. Clin Nucl Med 2022; 47:830-831. [PMID: 35695745 DOI: 10.1097/rlu.0000000000004313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Vitamin B12 deficiency may present with diverse symptoms, complicating the differential diagnosis. Extrapyramidal movement disorders, for instance, are a rare manifestation of vitamin B12 deficiency. MRI of the brain frequently remains without conclusive findings. However, 18 F-FDG PET/CT may reveal characteristic changes in the metabolism of the basal ganglia and thus contribute to an accurate diagnosis. We demonstrate the case of a woman with left-sided hemichoreatic movements due to vitamin B12 deficiency showing a contralateral putaminal hypermetabolism, which normalized after vitamin B12 supplementation, ruling out other deviating causes, particularly Huntington disease.
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Affiliation(s)
| | - Falk Gühne
- Nuclear Medicine, Jena University Hospital, Jena, Germany
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Sun Z, Yu X. A case report: subacute combined degeneration of the spinal cord and pernicious anemia caused by autoimmune gastritis. Medicine (Baltimore) 2022; 101:e29226. [PMID: 35777065 PMCID: PMC9239667 DOI: 10.1097/md.0000000000029226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Autoimmune gastritis causing both subacute combined degeneration of the spinal cord and pernicious anemia is rare in clinical practice. Here, we report a case of subacute combined degeneration of the spinal cord and pernicious anemia resulting from vitamin B12 deficiency due to autoimmune gastritis. PATIENT CONCERNS A 66-year-old woman presented with a 2-month history of numbness in her extremities. DIAGNOSES The diagnoses were (1) autoimmune gastritis (2) subacute combined degeneration of the spinal cord (3) pernicious anemia (4) hypergastrinemia (5) chronic lymphocytic thyroiditis. INTERVENTIONS The patient received intramuscular methylcobalamin treatment for 5 days, followed by oral methylcobalamin daily.Outcomes: Symptoms improved, and anemia recovered in the second month after discharge. She discontinued her medication afterward, and the neurological symptoms recurred. CONCLUSIONS Autoimmune gastritis can lead to several diseases if not intervened in the early course. Neuropathy and hematopathy recur with treatment discontinuity. Methylcobalamin and adenosylcobalamin are unlikely to be more effective than vitamin B12.
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Affiliation(s)
- Zhihuan Sun
- From the Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Pudong New District, Shanghai, China
| | - Xiaofei Yu
- From the Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Pudong New District, Shanghai, China
- *Correspondence: Xiaofei Yu, the Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Pudong New District, Shanghai, China (e-mail: )
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42
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Silverstein WK, Cheung MC, Lin Y. Vitamin B 12 deficiency. CMAJ 2022; 194:E843. [PMID: 35724997 PMCID: PMC9261952 DOI: 10.1503/cmaj.220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- William K Silverstein
- Department of Medicine (Silverstein, Cheung, Lin), University of Toronto; Division of Medical Oncology & Hematology (Cheung, Lin), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont.
| | - Matthew C Cheung
- Department of Medicine (Silverstein, Cheung, Lin), University of Toronto; Division of Medical Oncology & Hematology (Cheung, Lin), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont
| | - Yulia Lin
- Department of Medicine (Silverstein, Cheung, Lin), University of Toronto; Division of Medical Oncology & Hematology (Cheung, Lin), Sunnybrook Health Sciences Centre; ICES Central (Cheung); Precision Diagnostics and Therapeutics Program (Lin), Sunnybrook Health Sciences Centre; Department of Laboratory Medicine and Pathobiology (Lin), University of Toronto, Toronto, Ont
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Wood WD, Elmaghrabi A, Gotway G, Wolf MTF. The roles of homocysteinemia and methylmalonic acidemia in kidney injury in atypical hemolytic uremic syndrome caused by cobalamin C deficiency. Pediatr Nephrol 2022; 37:1415-1418. [PMID: 34854955 PMCID: PMC9160205 DOI: 10.1007/s00467-021-05372-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cobalamin C (cblC), a vitamin B12 processing protein, plays a crucial role in metabolism for the conversion of homocysteine to methionine and methylmalonyl-CoA to succinyl-CoA. CblC deficiency, an inborn error of cobalamin processing, is a rare cause of atypical hemolytic-uremic syndrome (aHUS) and results in hyperhomocysteinemia and methylmalonic aciduria. Both substances are thought to contribute to thrombotic microangiopathy (TMA) in cblC deficiency patients. However, the roles of homocysteine and methylmalonic acid (MMA) in these patients remain unclear. We want to shed more light on the contributions of homocysteine and MMA levels as contributing factors for thrombotic microangiopathy (TMA)/aHUS by a follow-up of a cblC deficiency patient over 6 years. CASE DIAGNOSIS A 27-day-old Hispanic female presented with abnormal C3-carnitine on her newborn screen, poor feeding, decreased activity, and oligouria. She was diagnosed with cblC deficiency after laboratory results revealed elevated serum homocysteine, and serum MMA along with genetic testing showing a homozygous pathogenic frameshift variant in MMACHC. The patient developed aHUS and acute kidney injury (AKI), which resolved after appropriate therapy. Over 6 years, she continued to have normal kidney function with no thrombocytopenia despite persistently elevated homocysteine and MMA levels. CONCLUSION We question the roles of homocysteine and MMA as causative of aHUS/TMA in cblC deficiency as they remained elevated during follow-up but did not result in aHUS/TMA or AKI. Hyperhomocysteinemia and/or MMA caused by other metabolic diseases do not result in aHUS/TMA or AKI. This suggests that other nephrotoxic factors may trigger aHUS/TMA in cblC patients.
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Affiliation(s)
- William D Wood
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ayah Elmaghrabi
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Garrett Gotway
- Pediatric Genetics and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthias T F Wolf
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Mounsey A, Brendle DC, Flowers K. Oral vs. Intramuscular Vitamin B12 for Treating Vitamin B12 Deficiency. Am Fam Physician 2022; 105:663-664. [PMID: 35713630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Anne Mounsey
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David C Brendle
- MAHEC Boone Family Medicine Residency, Asheville, North Carolina
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45
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Dapueto G, Vomero A, García L. [Vitamin B12 deficiency in an infant child of a mother with pernicious anemia]. Andes Pediatr 2022; 93:410-415. [PMID: 35857012 DOI: 10.32641/andespediatr.v93i3.3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/15/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In infants, vitamin B12 deficiency is mainly due to nutritional deficiencies related to maternal deficit. Most cases of maternal deficiencies are associated with vegetarian diets. Pernicious anemia is an au toimmune disease that affects the absorption of this vitamin. Although it is less common than nutri tional deficiency, is also an important cause of maternal deficiency. OBJECTIVE to report a case of an infant with vitB12 deficiency, secondary to pernicious anemia in his mother, and to review the most important aspects of this disease in childhood. CLINICAL CASE Nine months-old male infant, without pathological perinatal history, exclusively breastfed, with persistent rejection of solid food from 6 months of age. One month before hospitalization, he progressively presented hyporesponsiveness, with fluctuating state of alertness, regression of motor development milestones, and vomiting. The blood count showed macrocytic anemia and neutropenia. Vitamin B12 deficiency was confirmed in the patient. He received treatment with intramuscular vitamin B12 with good clinical and laboratory response. Maternal B12 deficiency was confirmed as the cause of the infant's deficiency. Since the mother reported no dietary restrictions, anti-intrinsic factor and anti-parietal cell antibodies were measured, leading to the diagnosis of pernicious anemia. CONCLUSIONS Early recognition is essential to prevent the development of potentially irreversible neurological damage. Maternal pernicious ane mia should be considered in children with megaloblastic anemia, especially in those whose mothers do not follow vegetarian diets.
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Affiliation(s)
- Gabriel Dapueto
- Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Alejandra Vomero
- Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Loreley García
- Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Esposito G, Dottori L, Pivetta G, Ligato I, Dilaghi E, Lahner E. Pernicious Anemia: The Hematological Presentation of a Multifaceted Disorder Caused by Cobalamin Deficiency. Nutrients 2022; 14:nu14081672. [PMID: 35458234 PMCID: PMC9030741 DOI: 10.3390/nu14081672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
Pernicious anemia is still a neglected disorder in many medical contexts and is underdiagnosed in many patients. Pernicious anemia is linked to but different from autoimmune gastritis. Pernicious anemia occurs in a later stage of autoimmune atrophic gastritis when gastric intrinsic factor deficiency and consequent vitamin B12 deficiency may occur. The multifaceted nature of pernicious anemia is related to the important role of cobalamin, which, when deficient, may lead to several dysfunctions, and thus, the proteiform clinical presentations of pernicious anemia. Indeed, pernicious anemia may lead to potentially serious long-term complications related to micronutrient deficiencies and their consequences and the development of gastric cancer and type 1 gastric neuroendocrine tumors. When not recognized in a timely manner or when pernicious anemia is diagnosed with delay, these complications may be potentially life-threatening and sometimes irreversible. The current review aimed to focus on epidemiology, pathogenesis, and clinical presentations of pernicious anemia in an attempt to look beyond borders of medical specialties. It aimed to focus on micronutrient deficiencies besides the well-known vitamin B12 deficiency, the diagnostic approach for pernicious anemia, its long-term complications and optimal clinical management, and endoscopic surveillance of patients with pernicious anemia.
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Ailliet S, Vandenberghe R, Schiemsky T, Van Overbeke L, Demaerel P, Meersseman W, Cassiman D, Vermeersch P. A case of vitamin B12 deficiency neurological syndrome in a young adult due to late-onset cobalamin C (CblC) deficiency: a diagnostic challenge. Biochem Med (Zagreb) 2022; 32:020802. [PMID: 35464742 PMCID: PMC8996322 DOI: 10.11613/bm.2022.020802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022] Open
Abstract
Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic anaemia. We describe a case of late-onset cobalamin C deficiency which typically presents with normal serum vitamin B12 concentrations, posing an additional diagnostic challenge. A 23-year-old woman with decreased muscle strength and hallucinations was diagnosed with ‘catatonic depression’ and admitted to a residential mental health facility. She was referred to our hospital for further investigation 3 months later. Heteroanamnesis revealed that the symptoms had been evolving progressively over several months. Magnetic resonance imaging (MRI) of the brain showed diffuse symmetrical white matter lesions in both hemispheres. Routine laboratory tests including vitamin B12 and folic acid were normal except for a slight normocytic, normochromic anaemia. Over the next 6 weeks her symptoms deteriorated, and she became unresponsive to stimuli. A new MRI scan showed progression of the white matter lesions. The neurologist requested plasma homocysteine (Hcys) which was more than 8 times the upper limit of normal. Further testing revealed increased methylmalonic acid and the patient was diagnosed with adult-onset cobalamin C deficiency. This case illustrates that Hcys and/or methylmalonic acid should be determined in patients presenting with neuropsychiatric symptoms suggestive of vitamin B12 deficiency with a normal serum vitamin B12 to rule out a late-onset cobalamin C deficiency.
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Affiliation(s)
- Scott Ailliet
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rik Vandenberghe
- Clinical Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Toon Schiemsky
- Clinical Department of Laboratory Medicine, Ziekenhuis Oost-Limburg, Belgium
| | - Lode Van Overbeke
- Center of Metabolic Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Clinical Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Meersseman
- Center of Metabolic Diseases, University Hospitals Leuven, Leuven, Belgium
| | - David Cassiman
- Center of Metabolic Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Corresponding author:
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N RS, Sharma R, Sharma R. Pancytopenia: Etiology and it's Variables. J Assoc Physicians India 2022; 70:11-12. [PMID: 35443537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Current study intends to study the etiological profile of Pancytopenia and to identify the complete blood count (CBC), peripheral smear (PS) findings which are helpful in narrowing the differential diagnosis and in planning the additional investigations to arrive at a specific diagnosis. MATERIAL Hospital based observational study being conducted at tertiary centre, Jaipur. INCLUSION CRITERIA Patients >18 years, CBC on admission fulfilling criteria of pancytopenia as mentioned in definition. EXCLUSION CRITERIA Patients > 80 years, Patients on radiotherapy and chemotherapy., Observation :Mean age of patients was 35.42 years with majority (29.90%) patients with majority of patients were in 2nd and 3r decade of their life with male preponderance Male: female ratio is 1.15:1). Vitamin B-12 deficiency (34.02%), folate deficiency (18.55%) CLD (9.27%) were the most common cause of pancytopenia. CONCLUSION Detailed clinical history and meticulous physical examination along with baseline hematological investigations, provides invaluable information in the complete workup of pancytopenic patients, helping in systematic planning of further investigations to diagnose and ascertain the cause.
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49
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A. Herrero Pfnür I. Vitamin B12 Deficiency as the Cause. Dtsch Arztebl Int 2022; 119:216. [PMID: 35707837 PMCID: PMC9277128 DOI: 10.3238/arztebl.m2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Abstract
Vitamin B12 deficiency is a cause of reversible dementia that must be ruled out in the evaluation of neurocognitive decline. We present a case of neurocognitive decline secondary to B12 deficiency where the workup was obscured by multiple competing diagnoses and treatment with empiric B12 supplementation reversed symptoms. Although the pretest probability was low, the morbidity from undiagnosed B12 deficiency is high, warranting a trial of B12 supplementation that resolved the patient's symptoms.
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Affiliation(s)
- Christopher Wong
- Department of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Fuad Benyaminov
- Department of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Lauren Block
- Department of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
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