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Vitamin B12 Eksikliği Olan Çocuklarda Klinik ve Laboratuvar Bulguların ve Tanısal Zorlukların Değerlendirilmesi

Year 2022, Volume 10, Issue 1, 6 - 10, 15.03.2022
https://doi.org/10.21765/pprjournal.1053277

Abstract

Giriş: Vitamin B12 eksikliği saptanan sağlıklı çocukların klinik ve laboratuvar verilerini değerlendirdiğimiz çalışmamızda Vitamin B12 eksikliği tanısında Metilmalonik asit (MMA) ile homosistein düzeylerinin yararlarına ve tanıda karşılaşılan güçlüklere ve dikkat çekildi. Gereç ve Yöntem: Serum kobalamin düzeyleri 126.5 pg/ml'nin altında olan toplam 70 sağlıklı çocuk çalışmaya dahil edildi. Yaş, cinsiyet, serum B12 vitamini, idrar MMA, plazma homosistein düzeyleri, beyaz küre ve trombosit sayıları, hemoglobin, ortalama eritrosit hacmi (Mean Corpuscular Volume, MCV), ortalama trombosit hacmi (mean platelet volume, MPV), folik asit ve ferritin düzeyleri geriye dönük olarak incelendi. Vitamin B12 düzeylerini MMA ve homosistein düzeyleri ile karşılaştırmak için korelasyon analizi kullanıldı. Bulgular: Sağlıklı çocuklarda ortalama yaş 8.21±6.15 yıl olup %6.29'unda B12 vitamini eksikliği saptandı. Kobalamin seviyeleri 50-126 pg/ml arasında değişmekteydi ve ortalama 102.57±18.97 pg/ml olarak saptandı. İdrar MMA ve serum homosistein düzeyleri ortalaması sırasıyla 0,59±0,67 ng/ml ve 13,50±0,67 g/dl idi. Korelasyon katsayısı (r), MMA için -0.342, homosistein için -0.437’ydi ve orta derecede negatif olarak değerlendirildi. 36 hastada MMA seviyeleri, 48 hastada homosistein seviyeleri normaldi. Sonuç: Vitamin B12 eksikliği çocuklarda yaygın bir mikro besin eksikliğidir. Özellikle yüksek MMA ve homosistein düzeyleri gibi tipik laboratuvar bulguları göstermeyen sağlıklı çocuklarda vitamin B12 eksikliğinin teşhisi zor olabilir.

References

  • 1. Bunn H. F. Vitamin B12 and pernicious anemia--the dawn of molecular medicine. The New England journal of medicine.2014;370(8), 773–776.
  • 2. Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood,.2017;129(19), 2603–2611.
  • 3. Devalia, V., Hamilton, M. S., Molloy A. M. et al. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British journal of haematology. 2014;166(4), 496–513.
  • 4. Stabler S. P. Vitamin B12 deficiency. The New England journal of medicine. 2013;368(2), 149–160.
  • 5. Wetherilt, H., Ackurt, F., Brubacher, G. et al. Blood vitamin and mineral levels in 7-17 years old Turkish children. International journal for vitamin and nutrition research. 1992;62(1), 21–29.
  • 6. Çolak, A., Akşit, M. Z., Şimşek, N. et al. Iron, Folate and Vitamin B12 Status of Children and Adolescents: Single Center Study in the Aegean Region. Journal of Dr. Behcet Uz Children's Hospital. 2019;9(3).
  • 7. Öncel, K., Özbek, M. N., Onur, H. et al. Diyarbakır ilindeki çocuklarda ve adölesanlarda B12 vitamin ve folik asit düzeyleri. Dicle Tıp Dergisi. 2006;33(3), 163-169.
  • 8. Oberley, M. J., Yang, D. T. Laboratory testing for cobalamin deficiency in megaloblastic anemia. American journal of hematology. 2013;88(6),522–526.
  • 9. Carmel, R., Sarrai, M. Diagnosis and management of clinical and subclinical cobalamin deficiency: advances and controversies. Current hematology reports. 2006;5(1), 23-33.
  • 10. Devalia, V., Hamilton, M. S., Molloy, A. M. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British journal of haematology. 2014;166(4), 496-513.
  • 11. Nexo, E., Hoffmann-Lücke, E. Holotranscobalamin, a marker of vitamin B-12 status: analytical aspects and clinical utility. The American journal of clinical nutrition. 2011;94(1), 359S-365S.
  • 12. Valente, E., Scott, J. M., Ueland, P. M. et al. Diagnostic accuracy of holotranscobalamin, methylmalonic acid, serum cobalamin, and other indicators of tissue vitamin B12 status in the elderly. Clinical chemistry. 2011; 57(6), 856-863.
  • 13. Froese, D. S., Fowler, B., Baumgartner, M. R. Vitamin B12, folate, and the methionine remethylation cycle-biochemistry, pathways, and regulation. Journal of inherited metabolic disease. 2019;42(4), 673–685.
  • 14. Allen, R. H., Stabler, S. P., Savage, D. G. et al. Metabolic abnormalities in cobalamin (vitamin B12) and folate deficiency. FASEB journal: official publication of the Federation of American Societies for Experimental Biology.1993;7(14), 1344–1353.
  • 15. Sarper N. Demir Eksikliği Anemisi. Türkiye Klinikleri. 2009;78(1):6–14. 9.
  • 16. Gür, E., Yildiz, I., Celkan, T. et al. Prevalence of anemia and the risk factors among schoolchildren in Istanbul. Journal of tropical pediatrics. 2005; 51(6), 346–350.
  • 17. Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk pediatri arsivi. 2015;50(1) 11–19.

Evaluation of Clinical and Laboratory Findings and Diagnostic Difficulties in Children with Vitamin B12 Deficiency

Year 2022, Volume 10, Issue 1, 6 - 10, 15.03.2022
https://doi.org/10.21765/pprjournal.1053277

Abstract

Aim: In this study, we evaluated the clinical and laboratory data of healthy children with vitamin B12 deficiency. The benefits of methylmalonic acid (MMA) and homocysteine levels and the difficulties encountered in diagnosing vitamin B12 deficiency were pointed out. Materials and Methods: A total of 70 healthy children whose serum cobalamin levels were below 126.5 pg/ml were included in the study. The age, gender, serum vitamin B12, urine MMA, plasma homocysteine, white blood cell, hemoglobin, thrombocyte, main corpuscular volume (MCV), main platelet volume (MPV), folic acid, and ferritin levels were obtained retrospectively from the hospital’s medical records. The correlation analysis test compared vitamin B12 with MMA and homocysteine. Results: The mean age was 8.21±6.15 years, and vitamin B12 deficiency was found in 6.29% of healthy children. Cobalamin levels ranged from 50-126 pg/ml, with a mean of 102.57±18.97 pg/ml. Urine MMA and serum homocysteine levels were 0.59±0.67 ng/ml and 13.50±0.67 g/dl, respectively. The correlation coefficient value (r) was found to be -0.342 and -0.437, moderately negative for MMA and homocysteine, respectively. MMA levels were normal in 36 patients, and homocysteine levels were normal in 48 patients. Conclusions: Vitamin B12 deficiency is a common micronutrient deficiency in children. The diagnosis of vitamin B12 deficiency can be complex in healthy children who do not display typical laboratory findings, particularly elevated MMA and homocysteine.

References

  • 1. Bunn H. F. Vitamin B12 and pernicious anemia--the dawn of molecular medicine. The New England journal of medicine.2014;370(8), 773–776.
  • 2. Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood,.2017;129(19), 2603–2611.
  • 3. Devalia, V., Hamilton, M. S., Molloy A. M. et al. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British journal of haematology. 2014;166(4), 496–513.
  • 4. Stabler S. P. Vitamin B12 deficiency. The New England journal of medicine. 2013;368(2), 149–160.
  • 5. Wetherilt, H., Ackurt, F., Brubacher, G. et al. Blood vitamin and mineral levels in 7-17 years old Turkish children. International journal for vitamin and nutrition research. 1992;62(1), 21–29.
  • 6. Çolak, A., Akşit, M. Z., Şimşek, N. et al. Iron, Folate and Vitamin B12 Status of Children and Adolescents: Single Center Study in the Aegean Region. Journal of Dr. Behcet Uz Children's Hospital. 2019;9(3).
  • 7. Öncel, K., Özbek, M. N., Onur, H. et al. Diyarbakır ilindeki çocuklarda ve adölesanlarda B12 vitamin ve folik asit düzeyleri. Dicle Tıp Dergisi. 2006;33(3), 163-169.
  • 8. Oberley, M. J., Yang, D. T. Laboratory testing for cobalamin deficiency in megaloblastic anemia. American journal of hematology. 2013;88(6),522–526.
  • 9. Carmel, R., Sarrai, M. Diagnosis and management of clinical and subclinical cobalamin deficiency: advances and controversies. Current hematology reports. 2006;5(1), 23-33.
  • 10. Devalia, V., Hamilton, M. S., Molloy, A. M. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British journal of haematology. 2014;166(4), 496-513.
  • 11. Nexo, E., Hoffmann-Lücke, E. Holotranscobalamin, a marker of vitamin B-12 status: analytical aspects and clinical utility. The American journal of clinical nutrition. 2011;94(1), 359S-365S.
  • 12. Valente, E., Scott, J. M., Ueland, P. M. et al. Diagnostic accuracy of holotranscobalamin, methylmalonic acid, serum cobalamin, and other indicators of tissue vitamin B12 status in the elderly. Clinical chemistry. 2011; 57(6), 856-863.
  • 13. Froese, D. S., Fowler, B., Baumgartner, M. R. Vitamin B12, folate, and the methionine remethylation cycle-biochemistry, pathways, and regulation. Journal of inherited metabolic disease. 2019;42(4), 673–685.
  • 14. Allen, R. H., Stabler, S. P., Savage, D. G. et al. Metabolic abnormalities in cobalamin (vitamin B12) and folate deficiency. FASEB journal: official publication of the Federation of American Societies for Experimental Biology.1993;7(14), 1344–1353.
  • 15. Sarper N. Demir Eksikliği Anemisi. Türkiye Klinikleri. 2009;78(1):6–14. 9.
  • 16. Gür, E., Yildiz, I., Celkan, T. et al. Prevalence of anemia and the risk factors among schoolchildren in Istanbul. Journal of tropical pediatrics. 2005; 51(6), 346–350.
  • 17. Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk pediatri arsivi. 2015;50(1) 11–19.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Cüneyt KARAGÖL (Primary Author)
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
0000-0002-2987-1980
Türkiye


Metin YİĞİT
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
0000-0003-3536-4456
Türkiye

Supporting Institution yok
Project Number yok
Publication Date March 15, 2022
Acceptance Date January 28, 2022
Published in Issue Year 2022, Volume 10, Issue 1

Cite

Vancouver Karagöl C. , Yiğit M. Evaluation of Clinical and Laboratory Findings and Diagnostic Difficulties in Children with Vitamin B12 Deficiency. Pediatric Practice and Research. 2022; 10(1): 6-10.