Vitamin B12 Deficiency Associated With Low Breast-Milk Vitamin B12 Concentration in an Infant Following Maternal Gastric Bypass Surgery

Abstract 5275 Background: Copper is an essential trace element that is required for the function of a number of enzymes necessary for normal metabolic activities including ferroxidase I (ceruloplasmin) which functions to release iron from cells with mobilizable iron stores. Copper deficiency is well reported in the literature but is considered relatively rare. It appears primarily to result from poor absorption, even though the precise mechanism(s) may not be apparent in all cases. Importantly, copper deficiency is a masquerader. It frequently results in manifestations that could easily be mistaken for another condition leading potentially to misdiagnosis and inappropriate therapy. Unlike vitamin B12 and folate deficiencies however, many guidelines and textbooks make no mention of copper deficiency as a potential secondary cause for a myelodysplasia (MDS)-like presentation or neuropathy even though multiple reports have described these associations. Methods and Results: In order to formally explore physician awareness about copper deficiency at our own institution we reviewed the medical records of 46 patients that were referred to the department of Hematology and/or Neurology at the Louisville Veterans Affairs Medical Center by their primary care physicians during the year 2010. 23 (49%) and 24 (51%) patients were referred for cytopenia (s) / macrocytosis and/or peripheral neuropathy respectively. however; no clearly identifiable etiology was found. Among patients with cytopenia (s) / macrocytosis, 34.8% (n=8) had concomitant peripheral neuropathy, 91.3% (n=21) presented with anemia as a part of their cytopenia (s); of those, 43% (n=9) were deficient in Iron without any clear etiology and 8.7% (n=2) were diagnosed with myelodysplatic syndrome. 100% (23) of patients with cytopenia (s)/macrocytosis were evaluated for Folic Acid and B12 deficiency either by their Primary care physician or hematologist. Only two patients (8.7%) were diagnosed with B12 deficiency, of those, one (4.3%) was referred because of isolated macrocytosis with a normal serum copper level checked by the hematologist. 100% (n=24) of patients referred to the neurology clinic with peripheral neuropathy were evaluated for Folic Acid and B12 deficiency, all with normal results. However, none were evaluated for copper deficiency including one patient with a history of gastric bypass surgery. Among these patients, 47.8% (n=11) were identified with isolated peripheral neuropathy, 8.3% with concomitant anemia, 8.3% with thrombocytopenia, 33.3% (n=8) with diabetes mellitus or impaired glucose tolerance test, 12.5% (n=3) with a history of alcohol abuse, 4.2% (n=1) with a positive HIV test and 4.2% (n=1) with a history of gastric bypass surgery with concomitant thrombocytopenia. Conclusion: Our study albeit small and from a single institution points to a significant lack of awareness among physicians about copper deficiency as a possible diagnostic consideration in patients with cytopenias and/or neuropathy even though it has been clearly reported in the literature to be associated with a clinical presentation very similar to B12 deficiency. We believe that this is representative of the prevailing practice pattern in the medical community as a whole. It is understandable therefore that we do not really know the true incidence of a disorder that is rarely tested even in patients presenting with known clinical features associated with it. Finally, one of the most compelling reasons to recognize copper deficiency is that like B12 deficiency, this is a potentially devastating condition that is treatable with simple replacement therapy. Disclaimer: The contents of this abstract do not represent the views of the Department of Veterans Affairs or the US government. Disclosures: No relevant conflicts of interest to declare.

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Prevalence of Iron, Folate, and Vitamin B12 Deficiency Anemia After Laparoscopic Roux-en-Y Gastric Bypass

Obesity Surgery ◽

10.1007/s11695-007-9310-0 ◽

2008 ◽

Vol 18 (3) ◽

pp. 288-293 ◽

Cited By ~ 141

Author(s):

Angel G. Vargas-Ruiz ◽

Gabriela Hernández-Rivera ◽

Miguel F. Herrera

Keyword(s):

Gastric Bypass ◽

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Deficiency Anemia ◽

B12 Deficiency ◽

Folate And Vitamin B12

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55: The Risk of Vitamin B12 Deficiency is Low after Ileal Orthotopic Bladder Substitution

The Journal of Urology ◽

10.1016/s0022-5347(18)37317-8 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 15-15

Author(s):

Urs E. Studer ◽

Richard Aebischer ◽

Katharina Ochsner ◽

Werner W. Hochreiter

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

B12 Deficiency ◽

Bladder Substitution

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Neurologic Sequelae Tied to Gastric Bypass Surgery

Internal Medicine News ◽

10.1016/s1097-8690(07)70786-2 ◽

2007 ◽

Vol 40 (13) ◽

pp. 24-25

Author(s):

ELIZABETH MECHCATIE

Keyword(s):

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Neurologic Sequelae

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Abstract #607: Gastric Bypass Surgery is Associated with A Reduction in Vasoconstrictive Mediators

Endocrine Practice ◽

10.1016/s1530-891x(20)44484-2 ◽

2017 ◽

Vol 23 ◽

pp. 124-125

Author(s):

Paresh Dandona ◽

Husam Ghanim ◽

Scott Monte ◽

Joseph Caruana ◽

Mayuri Mudgal ◽

...

Keyword(s):

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery

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Bioavailability of Vitamin B12

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000041 ◽

2010 ◽

Vol 80 (45) ◽

pp. 330-335 ◽

Cited By ~ 28

Author(s):

Lindsay Helen Allen

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

The Elderly ◽

Radioactive Isotopes ◽

Animal Source Foods ◽

Dietary Requirements ◽

In Vivo Labeling ◽

B12 Deficiency ◽

Vitamin B12 Malabsorption

Vitamin B12 deficiency is common in people of all ages who consume a low intake of animal-source foods, including populations in developing countries. It is also prevalent among the elderly, even in wealthier countries, due to their malabsorption of B12 from food. Several methods have been applied to diagnose vitamin B12 malabsorption, including Schillings test, which is now used rarely, but these do not quantify percent bioavailability. Most of the information on B12 bioavailability from foods was collected 40 to 50 years ago, using radioactive isotopes of cobalt to label the corrinoid ring. The data are sparse, and the level of radioactivity required for in vivo labeling of animal tissues can be prohibitive. A newer method under development uses a low dose of radioactivity as 14C-labeled B12, with measurement of the isotope excreted in urine and feces by accelerator mass spectrometry. This test has revealed that the unabsorbed vitamin is degraded in the intestine. The percent bioavailability is inversely proportional to the dose consumed due to saturation of the active absorption process, even within the range of usual intake from foods. This has important implications for the assessment and interpretation of bioavailability values, setting dietary requirements, and interpreting relationships between intake and status of the vitamin.

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Increased monocyte to HDL cholesterol ratio in vitamin B12 deficiency: is it related to cardiometabolic risk?

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000668 ◽

2020 ◽

pp. 1-8

Author(s):

Sanem Kayhan ◽

Nazli Gulsoy Kirnap ◽

Mercan Tastemur

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Uric Acid ◽

Vitamin B12 ◽

Cardiometabolic Risk ◽

Vitamin B12 Deficiency ◽

Left Ventricular ◽

Cardiometabolic Risk Factors ◽

B12 Deficiency ◽

Deficiency Group

Abstract. Vitamin B12 deficiency may have indirect cardiovascular effects in addition to hematological and neuropsychiatric symptoms. It was shown that the monocyte count-to-high density lipoprotein cholesterol (HDL-C) ratio (MHR) is a novel cardiovascular marker. In this study, the aim was to evaluate whether MHR was high in patients with vitamin B12 deficiency and its relationship with cardiometabolic risk factors. The study included 128 patients diagnosed with vitamin B12 deficiency and 93 healthy controls. Patients with vitamin B12 deficiency had significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), MHR, C-reactive protein (CRP) and uric acid levels compared with the controls (median 139 vs 115 mmHg, p < 0.001; 80 vs 70 mmHg, p < 0.001; 14.2 vs 9.5, p < 0.001; 10.2 vs 4 mg/dl p < 0.001; 6.68 vs 4.8 mg/dl, p < 0.001 respectively). The prevalence of left ventricular hypertrophy was higher in vitamin B12 deficiency group (43.8%) than the control group (8.6%) (p < 0.001). In vitamin B12 deficiency group, a positive correlation was detected between MHR and SBP, CRP and uric acid (p < 0.001 r:0.34, p < 0.001 r:0.30, p < 0.001 r:0.5, respectively) and a significant negative correlation was detected between MHR and T-CHOL, LDL, HDL and B12 (p < 0.001 r: −0.39, p < 0.001 r: −0.34, p < 0.001 r: −0.57, p < 0.04 r: −0.17, respectively). MHR was high in vitamin B12 deficiency group, and correlated with the cardiometabolic risk factors in this group, which were SBP, CRP, uric acid and HDL. In conclusion, MRH, which can be easily calculated in clinical practice, can be a useful marker to assess cardiovascular risk in patients with vitamin B12 deficiency.

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