Detection of vitamin B12 levels with the aid of some hematological and biochemical parameters that are more sensitive

Year 2010, Volume: 14 Issue: 3, 125 - 129, 06.03.2014

Süheyl Asma Ferit Erdoğan Aydan Ünsal Can Boğa Hakan Özdoğu Çiğdem Gereklioğlu İlknur Kozanoğlu Erkan Maytalman

Abstract

ABSTRACT: Vitamin B12 deficiency is a health problem, which is usually seen in elderly patients
and results in hematological and neurological disorders. In this study, we aimed to
investigate the serum levels of vitamin B12 could represent the real tissue levels with considering
some hematological and biochemical parameters. 128 patients whose vitamin B12
levels have been detected to be low and their ages are ranged from 16 to 90, have been investigated.
Fifty three of them were females. Complete blood counts, antiparietal antibody
(APA), homocysteine levels, peripheral blood smear evaluations and findings of gastroduodenoscopy
were assessed. Mean volume of erythrocytes has been found as 107 fl in patient
group (group 1), in which vitamin B12 level has been detected lower than 60 pg/mL. The
higher homocysteine values in 85% cases, neutrophil hyper-segmentation in 82%, atrophic
gastritis in 53 % and APA positivity in 47 % of cases have been detected. The average of age
has been detected as 65 in this group. High level of homocysteine has been present in 44 %
of cases and MCV has been 91 fl in group 2, in which the vitamin B12 levels are between
61–100 pg/ mL. In group ( group 3), in which vitamin levels are between 101 – 140 pg /mL,
elevated homocysteine levels in 27 % cases and MCV as 89 fl have been detected. In group
4, in which vitamin levels are between 141–178 pg/mL, homocysteine elevation in 16 % of
cases and MCV as
KEY WORDS: Vitamin B 12, homocysteine, anti parietal antibod

Keywords

-

Detection of vitamin B12 levels with the aid of some hematological and biochemical parameters that are more sensitive

Abstract

Vitamin B12 eksikliği genellikle yaşlı hastalarda karşılaşılan, hematolojik ve nörolojik rahatsızlara sebep olan önemli bir sağlık sorunudur. Bazı hastalarda serum vitamin B12 düzeylerinin gerçek düzeyi tam olarak yansıtmadığı düşünülmektedir. Bu çalışmamızda vitamin B12 serum düzeylerinin, bazı hematolojik ve biyokimyasal parametreleri dikkate alarak, hangi düzeylerin gerçek doku düzeylerini yansıtabileceğini amaçladık. Gereç ve Yöntem: Vitamin B12 düzeyi düşük saptanan yaşları 16 ile 90 arasında, 91’i kadın 138 hasta incelendi. Hastaların tam kan sayımı, anti parietal antikor (APA), folik asit, homosistein ve periferik yayma değerlendirmesi ile gastroduodenoskopi bulguları değerlendirildi. Bulgular: Vitamin B12 düzeyi 60 pg/mL’ın altında saptanan hasta grubunda (Grup 1), ortalama alyuvar hacmi (OEH) 105 Fl olarak bulundu. Yüksek homosistein değerleri homosistein % 87 olguda, nötrofillerde hipersegmentasyon % 80, atrofik gastrit % 52 ve APA pozitifliği % 45 oranında saptandı. Bu gruptaki hastaların yaş ortalamaları 65.1 olarak belirlendi. Vitamin B12 seviyesi 61-100 pg/mL olan grupta (Grup 2) homosistein yüksekliği % 45, OEH 79Fl olduğu tespit edildi. Vitamin düzeyleri 101-140 pg/mL’ın arasındaki grupta ise (Grup 3) homosistein yüksekliği % 21, OEH 80 ve 141-178 pg/mL arasında olan grupta ise (Grup 4) homosistein yüksekliği % 16 ve OEH 76 olduğu belirlendi. Grup 1 dışındaki gruplarda homosistein, APA pozitifliği, OEH ve hipersegmentasyon değerlerinin anlamlı şekilde azaldığı belirlendi. Sonuç: Bu çalışma sonucunda referans değerlerinin altındaki serum vitamin B12 düzeyinin gerçek doku düzeyini yansıtmayabileceği, vitamin B12 düzeyi 60 pg/mL ve altındaki değerlerin daha özgül olduğu saptandı

Keywords

ANAHTAR KELİMELER: Vitamin B 12, homosistein, antiparietal antikor

References

• Carmel R, Green R, Rosenblatt DS, Watkins D. Update on Cobalamin, Folate, and Homocysteine. Hematology Am Soc Hematol Educ Program 1: 62-81, 2003.
• Van Der Put NM, Steegers-Theunissen RP, Frosst P. Mu- tated methylene tetrahydrofolate reductase as a risk fac- tor for spina bifida. Lancet 346:1070-1071, 1995.
• Klerk M, Verhoef P, Clarke R. MTHFR 677C→T poly- morphism and risk of coronary heart disease: a meta analysis. JAMA 288: 2023-2031, 2002.
• Sipponen P, Laxen F, Huotari K, Harkonen M. Prevalence of low vitamin B12 and high homocysteine in serum in an elderly male population: association with atrophic gastritis and Helicobacter pylori infection. Scand J Gas- troenterol 38: 1209–16, 2003.
• Clarke R, Grimley EJ, Schneede J et al. Vitamin B12 and folate deficiency in later life. Age Ageing 33: 34–41, 2004.
• Lechner K, Födinger M, Grisold W, et al. Vitamin B12 deficiency. New data on an old theme. Wien Klin Wo- chenschr. 117:579-91, 2005.
• Wiersinga WJ, de Rooij SE, Huijmans JG et al. Diagno- sis of vitamin B12 deficiency revised. Ned Tijdschr Ge- neeskd. 149:2789-94, 2005.
• Antony AC. Megaloblastic anemias. Hoffman R, Benz EJ, Shattil SJ, Furie B. In: Hematology Basic Principles and Practice 3rd Ed., Churchill Livingstone Inc. Newyork, 2000, 446-484.
• Hvas AM, Ellegaard J, Nexo E. Increased plasma meth- ylmalonic acid level does not predict clinical manifesta- tions of vitamin B12 deficiency. Arch Intern Med 161: 1534-1541, 2001.
• Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Phy- sician 67: 993-994, 2003.
• Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency. Arch Intern Med 159: 1289-1298, 1999.
• Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sen- sitivity of serum methylmalonic acid and total homo- cysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med 96: 239–246, 1994.
• Hvas AM, Ellegaard J, Nexo E. Increased plasma meth- ylmalonic acid level does not predict clinical manifesta- tions of vitamin B12 deficiency. Arch Intern Med 161: 1534-1541, 2001.
• Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency. Blood 76: 871–881, 1990.
• Crayn, Elizabeth MD. Vitamin B12 deficiency; recogni- tion and management. Primary Care Case Reviews 5(2): 53-60, 2002.
• Röth A. Megaloblastaere Anaemien. Herold G. In: In- nere Medizin. © Gerd Herold, Köln; 2007, 27-31.
• Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician. Arch Intern Med 159:1289-98, 1999.
• Stabler SP. Screening the older population for cobalamin (vitamin B12) deficiency. J Am Geriatr Soc 43:1290-7, 1995.
• Henoun LN, Noel E, Ben AM et al. Cobalamin deficiency due to non-immune atrophic gastritis in elderly patients. A report of 25 cases. J Nutr Health Aging 9: 462, 2005.
• Kaptan K, Beyan C, Ural AU et al. Helicobacter pylori – is it a novel causative agent in Vitamin B12 deficiency? Arch Intern Med 160: 1349–53, 2000.
• Serin E, Gumurdulu Y, Ozer B et al. Impact of elicobacter pylori on the development of vitamin B12 deficiency in the absence of gastric atrophy. Helicobacter 7: 337–41, 2002.
• Lindenbaum J, Healton EB, Savage DG, et al. Neuropsy- chiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 318:1720-8, 1988.
• Lee GR. Pernicious anemia and other causes of vitamin B12 (cobalamin) deficiency. In: Lee GR, et al., eds. Win- trobe’s Clinical hematology. 10th ed. Baltimore: Wil- liams & Wilkins, 1999, 941-64.