Can New Advanced Clinical Parameters Be Used in the Diagnosis of Vitamin B12 Deficiency?

Yıl 2025, Cilt: 47 Sayı: 1, 8 - 15, 17.01.2025

Yavuz Uzun , Evin Kocatürk , Zeynep Kusku Kiraz , Hava Üsküdar Teke

https://doi.org/10.20515/otd.1529100

Öz

The measurement of vitamin B12 levels has low sensitivity for the diagnosis of vitamin B12 deficiency, therefore, clinicians may prefer to decide the deficiency with the patient's clinic. In this study, the diagnostic values of the classical and advanced clinical complete blood count parameters were investigated to find a new marker in the diagnosis of vitamin B12 deficiency. 150 adult volunteers were included in the study and volunteers were divided into two groups according to their vitamin B12 levels (with or without vitamin B12 deficiency) and hemoglobin levels (with or without anemia). The differences and correlations of laboratory test results between groups were examined. Equivalent of reticulocyte hemoglobin, equivalent of erythrocyte hemoglobin and delta-hemoglobin were found significant differences between groups with or without vitamin B12 deficiency. Hypo-hemoglobinised red cells and hyper-hemoglobinised red cells were found significant difference between groups with or without anemia. Significant positive correlations were found between vitamin B12 levels and equivalent of reticulocyte hemoglobin, equivalent of erythrocyte hemoglobin and delta-hemoglobin. Significant positive correlations were found between hemoglobin levels and macrocytic red blood cells, equivalent of reticulocyte hemoglobin, equivalent of erythrocyte hemoglobin, delta hemoglobin and hyper-hemoglobinised red cells; negative correlations with microcytic red blood cells and hypo-hemoglobinised red cells. It is suggested that these advanced clinical parameters of complete blood count analysis may be used to determine vitamin B12 deficiency.

Anahtar Kelimeler

Vitamin B12 deficiency, Anemia, Complete Blood Count, Erythrocytes, Reticulocytes

Etik Beyan

Ethics Committee Approval: The study was approved by Eskişehir Osmangazi University Noninterventional Clinical Research Ethical Committee (Decision no: 23, Date: 16.10.2020). Informed Consent: It is declared that the patient signed an informed consent form. Authorship Contributions: Concept: YU, EK, ZKK Design: YU, EK, ZKK, HUT Data Collection or Processing: YU, EK, HUT. Analysis or Interpretation: YU, EK. Literature Search: YU, EK. Writing: YU, EK, ZKK, HUT. Copyright Transfer Form: Copyright Transfer Form was signed by all authors. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: This article is produced from Mr. Uzun’s thesis of master named ‘Investigation of Relationship Between Vitamin B12 Deficiency with Whole Blood Count Parameters’. The authors declared that this study received no financial support.

Teşekkür

Acknowledgment: Statistical analysis was performed by Prof. Dr. Huseyin Kayabidi

B12 Vitamini Eksikliğinin Tanısında Yeni Gelişmiş Klinik Parametreler Kullanılabilir mi?

Öz

B12 vitamini düzeylerinin ölçümünün B12 vitamini eksikliği tanısında duyarlılığı düşüktür, bu nedenle, klinisyenler eksikliğe hastanın kliniği ile karar vermeyi tercih edebilir. Bu çalışmada B12 vitamini eksikliği tanısında yeni bir belirteç bulmak amacıyla klasik ve ileri klinik tam kan sayımı parametrelerinin tanısal değerleri araştırıldı. Çalışmaya 150 yetişkin gönüllü dahil edildi ve gönüllüler B12 vitamini düzeylerine (B12 vitamini eksikliği olan veya olmayan) ve hemoglobin düzeylerine (kansızlık olan veya olmayan) göre iki gruba ayrıldı. Laboratuvar test sonuçlarının gruplar arasındaki farklılıkları ve korelasyonları incelendi. B12 vitamini eksikliği olan ve olmayan gruplar arasında retikülosit hemoglobini, eritrosit hemoglobin ve delta-hemoglobin açısından anlamlı farklar bulundu. Anemisi olan ve olmayan gruplar arasında hipo-hemoglobinize eritrositler ve hiper-hemoglobinize kırmızı hücreler arasında anlamlı fark bulundu. B12 vitamini düzeyleri ile retikülosit hemoglobini, eritrosit hemoglobin ve delta-hemoglobin arasında anlamlı pozitif korelasyon bulundu. Hemoglobin seviyeleri ile makrositik eritrositler, retikülosit hemoglobini, eritrosit hemoglobini, delta hemoglobin ve hiper-hemoglobinize eritrositler arasında anlamlı pozitif korelasyonlar; mikrositik eritrositler ve hipo-hemoglobinize eritrosit düzeyleri ile negatif korelasyonlar bulundu. Tam kan sayımı analizinin bu ileri klinik parametrelerinin B12 vitamini eksikliğini belirlemek için kullanılabileceği öne sürülmektedir.

Anahtar Kelimeler

B 12 Vitamini Eksikliği, Anemi, Tam kan sayımı, Eritrositler, Retikülositler

Etik Beyan

This article is produced from Mr. Uzun’s thesis of master named ‘Investigation of Relationship Between Vitamin B12 Deficiency with Whole Blood Count Parameters’. Ethics Committee Approval: The study was approved by Eskişehir Osmangazi University Noninterventional Clinical Research Ethical Committee (Decision no: 23, Date: 16.10.2020). Informed Consent: It is declared that the patient signed an informed consent form. Authorship Contributions: Concept: YU, EK, ZKK Design: YU, EK, ZKK, HUT Data Collection or Processing: YU, EK, HUT. Analysis or Interpretation: YU, EK. Literature Search: YU, EK. Writing: YU, EK, ZKK, HUT. Copyright Transfer Form: Copyright Transfer Form was signed by corresponding author. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Teşekkür

Statistical analysis was performed by Prof. Dr. Huseyin Kayabidi.

Kaynakça

• 1. Carmel R. Current concepts in cobalamin deficiency. Annu Rev Med. 2020;51:357-375.
• 2. Hvas AM, Nexo E. Diagnosis and treatment of vitamin B 12 deficiency. An update. Haematologica. 2006;91:1506-1512.
• 3. Kesiktaş N, Eskiyurt N, Karan A, et al. Relation of Vitamin B12 Levels to Bone Mineral Density of Postmenopausal Women. Turk J Osteoporos. 2009;15:1-6.
• 4. Hannibal L, Lysne V, Bjørke-Monsen AL, et al. Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency. Front Mol Biosci. 2016;27:3:27.
• 5. Refsum H, Smith AD, Ueland PM, et al. Facts and recommendations about total homocysteine determinations: an expert opinion. Clin Chem. 2004;50:3–32.
• 6. Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency. Arch Intern Med. 1999;159:1289-1298.
• 7. Barbosa PR, Stabler SP, Machado AL, et al Association between decreased vitamin levels and MTHFR, MTR and MTRR gene polymorphisms as determinants for elevated total homocysteine concentrations in pregnant women. Eur J Clin Nutr. 2008;62:1010–1021.
• 8. Metz J, Bell AH, Flicker L, et al. The significance of subnormal serum vitamin B12, concentration in older people: a case control study. J Am Geriatr Soc. 1996;44:1355–1361.
• 9. Thomson ABR, Sauve MD, Kassam N, Kamitakahara H. Safety of the long-term use of proton pump inhibitors. World J Gastroenterol. 2010;16(19):2323–2330.
• 10. Emen B, Öztürk Y, Eren MA, et al. Retrospective Analysis of the Correlation of Etiological Factors with Laboratory Features in Vitamin B12 Defficient Patients. The journal of Tepecik Education and Research Hospital. 2013;23(1):19-23.
• 11. Advanced clinical and research parameters in haematology. (sysmex-europe website). https://www.sysmex-europe.com/academy/knowledge-centre/sysmex-parameters.html Accessed October 14, 2021.
• 12. Schapkaitz E. Stability of New Erythrocyte and Reticulocyte Parameters in Testing for Anemia on the Sysmex XN 9000. Lab Med. 2018;49(3):219-225.
• 13. Badireddy M, Baradhi KM. Chronic Anemia. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Bookshelf ID: NBK534803, https://www.ncbi.nlm.nih.gov/books/NBK534803/
• 14. Nielsen MJ, Rasmussen MR, Andersen CB, et al. Vitamin B12 transport from food to the body's cells--a sophisticated, multistep pathway. Nat Rev Gastroenterol Hepatol. 2012;9(6):345-354.
• 15. Carmel R, Green R, Rosenblatt DS, Watkins D. Update on cobalamin, folate, and homocysteine. Hematology Am Soc Hematol Educ Program. 2003;62-81.
• 16. Ocakçı S. Approach to iron and B12 deficiency anemia in primary care. Smyrna Medical Journal. 2012;1:51-53.
• 17. Baytan B, Özdemir Ö, Erdemir G, Güneş AM. Vitamin B12 Deficiency: The Clinical Features and Treatment During Childhood. Journal of Uludağ University Medical Facult. 2007;33:61-64.
• 18. Maconi M, Cavalca L, Danise P, et al. Erythrocyte and reticulocyte indices in iron deficiency in chronic kidney disease: comparison of two methods. Scand J Clin Lab Invest. 2009;69(3):365–370.
• 19. Toki Y, Ikuta K, Kawahara Y, et al. Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency. Int J Hematol. 2017;106(1):116–125.
• 20. Weimann A, Cremer M, Hernáiz-Driever P, Zimmermann M. Delta-He, Ret-He and a New Diagnostic Plot for Differential Diagnosis and Therapy Monitoring of Patients Suffering from Various Disease-Specific Types of Anemia. Clin Lab. 2016;62(4):667-677.