Abstract

Background: In this study, our intent was to determine whether serum levels of B12 and folic acid in patients diagnosed with iron deficiency anemia undergo change in response to iron supplements. Methods: In this retrospective study, 202 female patients with iron deficiency anemia and only iron treatment were included. Complete blood count, vitamin B12, ferritin, folate levels of patients at the time of initial presentation and 4-8 weeks after treatment were examined. Results: Overall, significant increases were detected in mean hemoglobin, mean hematocrit, mean mean corpuscular volume, median white blood cell and median serum ferritin levels in all patients treated with iron therapy (both oral and intravenous); significant decreases were observed in post-treatment median platelet, median folate, and median B12 levels in this patient cohort. Conclusions: We conclude that deficiencies in serum levels B12, folate and iron, which are critical factors promoting erythropoiesis may effectively mask one another in a basic clinical assessment of anemia.

Keywords

• vitamin b12
• folic acid
• iron therapy
• Iron deficiency anemia

Demir eksikliği anemisinde demir tedavisi sonrası B12 vitamini ve folik asit seviyeleri

Öz

Giriş: Bu çalışmada amacımız, demir eksikliği anemisi teşhisi konulan hastalarda serum B12 ve folik asit düzeylerinin demir takviyesine yanıt olarak değişip değişmediğini belirlemekti. Materyal metod: Bu retrospektif çalışmaya demir eksikliği anemisi olan ve sadece demir tedavisi olan 202 kadın hasta dahil edildi. Hastaların ilk başvuru anında ve tedaviden 4-8 hafta sonra tam kan sayımı, B12 vitamini, ferritin, folat seviyeleri incelendi. Bulgular: Genel olarak, demir tedavisi ile tedavi edilen tüm hastalarda (hem oral hem de intravenöz) ortalama hemoglobin, ortalama hematokrit, ortalama korpüsküler hacim, medyan beyaz kan hücresi ve medyan serum ferritin seviyelerinde önemli artışlar tespit edildi; bu hasta kohortunda tedavi sonrası medyan trombosit, medyan folat ve medyan B12 seviyelerinde önemli düşüşler gözlenmiştir. Sonuç: Eritropoezi teşvik eden kritik faktörler olan serum B12, folat ve demir seviyelerindeki eksikliklerin, aneminin temel bir klinik değerlendirmesinde birbirini etkili bir şekilde maskeleyebileceği sonucuna vardık.

Anahtar Kelimeler

• vitamin B12
• folik asit
• demir eksikliği anemisi
• demir tedavisi

Kaynakça

1. World Health Organization, World Health Organization, Geneva. Iron deficiency anaemia: assessment, prevention and control. A guide for programme managers. Google Sch. 2001.
2. Koury MJ, Ponka P. New insights into erythropoiesis: the roles of folate, vitamin B12, and iron. Annu Rev Nutr. 2004;24:105-131.
3. Kim A, Nemeth E. New insights into iron regulation and erythropoiesis. Curr Opin Hematol. 2015;22(3):199-205.
4. Ralley FE. Erythropoietin and intravenous iron in PBM. Transfus Apher Sci. 2014;50:16-19.
5. Roberts PD, St John DJ, Sinha R et al. Apparent folate deficiency in iron-deficiency anaemia. Br J Haematol. 1971;20:165-176.
6. Velez H, Restrepo A, Vitale JJ, Hellerstein EE. Folic acid deficiency secondary to iron deficiency in man. Remission with iron therapy and a diet low in folic acid. Am J Clin Nutr. 1966;19:27-36.
7. Vitale JJ, Restrepo A, Velez H, Riker JB, Hellerstein EE. Secondary folate deficiency induced in the rat by dietary iron deficiency. J Nutr. 1966;88:315-322.
8. Harrison RJ. Vitamin B12 levels in erythrocytes in hypochromic anaemia. J Clin Pathol. 1971;24:698-700.

9. Remacha AF, Wright I, Fernández-Jiménez MC, et al. Vitamin B12 and folate levels increase during treatment of iron deficiency anaemia in young adult woman. Int J Lab Hematol. 2015;37:641-648.
10. Metz J, Edelstein T, Divaris M, Zail SS. Effect of total dose infusion of iron-dextran on iron, folate, and vitamin B12 nutrition in postpartum anaemia. Br Med J. 1967;3:403-406.
11. Toh B-H. Pathophysiology and laboratory diagnosis of pernicious anemia. Immunol Res. 2017 ;65:326-330.
12. Berry N, Basha J, Varma N, et al. Anemia in celiac disease is multifactorial in etiology: A prospective study from India. JGH Open. 2018;2:196-200.
13. Solmaz S, Özdoğu H, Boğa C. Cobalamin deficiency can mask depleted body iron reserves. Indian J Hematol Blood Transfus. 2015;31:255-258.