scholarly journals Identification of vitamin B12 deficiency in vegetarian Indians

2018 ◽  
Vol 119 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Sadanand Naik ◽  
Namita Mahalle ◽  
Vijayshri Bhide
Keyword(s):  
Predictive Value ◽  
Characteristic Curve ◽  
Clinical Signs ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Diagnostic Value ◽  
Total Serum ◽  
Vitamin B ◽  
B12 Deficiency ◽  
Specific Uptake

AbstractThe prevalence of a sub-clinical vitamin B12 deficiency in the vegetarians is high. Total serum vitamin B12 concentration alone does not reliably reflect vitamin B12 status. Holotranscobalamin (holo-TC) II is a bioactive B12 fraction promoting specific uptake of B12 by cells and the circulating concentration reflects the intake of B12, whereas total homocysteine (tHcy) indicates the metabolic ability. In this study, we investigated the diagnostic value of circulating holo-TC, B12, folate and homocysteine in vegetarians who were at risk of B12 deficiency. B12-related biomarkers were measured in 119 young, healthy graduate vegetarians. None was folate deficient. As per reported definition, half were B12 deficient; 70 % of males and 50 % of females had low plasma holo-TC concentrations; and 92 % of males and half of females had hyperhomocysteinaemia. None had any clinical signs of B12 deficiency. Receiver operating characteristic curve analysis demonstrated similar AUC at the B12 concentration of 100 and 150 pmol/l when holo-TC (0·777 and 0·784) and homocysteine (0·924 and 0·928) were used as variables. Cut-off value of 100 pmol/l resulted in the highest sensitivity of 77·78 % and specificity of 71·05 % with a predictive value of 19·6 pmol/l for holo-TC and a sensitivity of 82·72 % and specificity of 89·7 % with a predictive value of 21·7 µmol/l for homocysteine. The combination of B12, holo-TC and tHcy improves the diagnostic accuracy at these cut-offs, and we suggest that for the young Indian vegetarians the cut-off for plasma B12 and holotrancobalamin is 100 pmol/l and 19·6 pmol/l, respectively, and for homocysteine it is 17·6 (females) and 27 µmol/l (males) for identifying B12 deficiency.

Ischemic strokes secondary to vitamin B12 deficiency-induced hyperhomocystinemia

Neurology ◽  
1998 ◽  
Vol 51 (2) ◽  
pp. 622-624 ◽  
Author(s):  
LaRoy P. Penix
Keyword(s):  
Mean Corpuscular Volume ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Vitamin B ◽  
Loading Test ◽  
Schilling Test ◽  
B12 Deficiency ◽  
Recurrent Strokes ◽  
Methionine Loading Test

A 45-year-old woman sustained two ischemic cerebral infarctions 16 years after ileal resection for Crohn's disease. Her evaluation showed an elevated random serum homocystine level, a low serum vitamin B12 level, and an increased mean corpuscular volume (MCV) without anemia. A methionine-loading test resulted in a marked increase in the homocystine levels 2, 4, and 6 hours after the load. A Schilling test demonstrated a malabsorption of vitamin B12. Vitamin B12 injections normalized her fasting homocystine level and her MCV. She has had no recurrent strokes during a year follow-up.

A Survey of Vitamin B12 Deficiency in an Elderly Psychiatric Population

1967 ◽  
Vol 113 (496) ◽  
pp. 241-251 ◽  
Author(s):  
R. Shulman
Keyword(s):  
Psychiatric Patients ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Pernicious Anaemia ◽  
Vitamin B ◽  
Cerebral Lesions ◽  
Mental Symptoms ◽  
B12 Deficiency ◽  
The Subject ◽  
Wassermann Reaction

For many years, cases of pernicious anaemia associated with mental symptoms have been described, and interest in these symptoms was renewed following the introduction of liver therapy (Richardson, 1929; Phillips, 1931). Interest later appeared to decline, so that MacDonald Holmes (1956), almost 20 years after the last important clinical review of the subject, could comment with justification that although the cerebral lesions of pernicious anaemia had been recognized for more than a century they were still much less familiar than the lesions which occurred in the spinal cord and peripheral nerves. Since then vitamin B12 deficiency as a cause of mental symptoms has given rise to increasing interest, and this is reflected in recent suggestions that serum vitamin B12 assays should be carried out routinely in psychiatric patients and might be more informative nowadays than the routine Wassermann reaction (Strachan and Henderson, 1965; Hunter and Matthews, 1965).

scholarly journals Holotranscobalamin – An Early Marker for Laboratory Diagnosis of Vitamin B12 Deficiency

2009 ◽  
Vol 03 (01) ◽  
pp. 7
Author(s):  
Wolfgang Herrmann ◽  
Rima Obeid ◽  
◽  
Keyword(s):  
At Risk ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Laboratory Diagnosis ◽  
Total Serum ◽  
Vitamin B ◽  
Active Portion ◽  
Negative Balance

Vitamin B12deficiency is widespread. Among the population groups at risk are older people, vegetarians, pregnant women and patients with renal or intestinal diseases. The neurological symptoms of vitamin B12deficiency are unspecific and can be irreversible. Early detection is therefore important. This article reviews the diagnostic performance of the different laboratory markers for vitamin B12status. Total serum vitamin B12is a relatively insensitive and unspecific biomarker of deficiency that does not reflect recent variations in cobalamin status. Holotranscobalamin (holoTC), the metabolically active portion of vitamin B12, is the earliest laboratory parameter that becomes decreased in case of a vitamin B12negative balance. Concentration of methylmalonic acid (MMA) is a functional vitamin B12marker that will increase when the vitamin B12stores are depleted. Isolated lowering of holoTC shows vitamin B12depletion (negative balance), while lowered holoTC plus elevated MMA (and homocysteine) indicates a metabolically manifested vitamin B12deficiency, although there still may be no clinical symptoms. The diagnostic use of holoTC allows the initiation of therapeutic measures before irreversible neurological damage develops. Because the clinical manifestations of vitamin B12deficiency are unspecific, people at risk should be identified and should regularly test their holoTC with or without MMA.

scholarly journals A Case of Subacute Combined Degeneration of Spinal Cord Diagnosed by Vitamin B12 Administration Lowering Methylmalonic Acid

2020 ◽  
Vol 12 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Daisuke Hara ◽  
Masashi Akamatsu ◽  
Heisuke Mizukami ◽  
Bunta Kato ◽  
Takaaki Suzuki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vitamin B12 ◽  
Methylmalonic Acid ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Lower Limbs ◽  
Total Serum ◽  
Subacute Combined Degeneration ◽  
Laboratory Findings ◽  
B12 Deficiency

Subacute combined degeneration of the spinal cord (SCDS) is a neurodegenerative disease characterized by subacute progression in the central and peripheral nervous systems mainly caused by vitamin B12 deficiency. It is known that typical SCDS is frequently accompanied by megaloblastic anemia and increased serum methylmalonic acid (MMA) or homocysteine (Hcy) levels on laboratory findings, and marked abnormalities on spinal cord magnetic resonance imaging (MRI). A 45-year-old woman was admitted to our hospital with a 2-year history of worsening mild weakness, numbness in bilateral lower limbs, and gait disturbance. On admission, as laboratory findings, blood count showed macrocytosis without anemia, and biochemical tests showed mild reduction in total serum vitamin B12 level and no increase of MMA and Hcy levels; there were no abnormal findings on spinal cord MRI. After administration of vitamin B12, her sensorimotor symptoms were improved and laboratory examination showed that macrocytosis was improved, serum vitamin B12 was increased, and serum MMA levels were decreased. This improved clinical course and the laboratory findings following vitamin B12 administration confirmed the diagnosis of SCDS due to vitamin B12 deficiency. SCDS presents with highly variable symptoms and laboratory findings, and observation of MMA levels and neurologic symptoms before and after vitamin B12 administration may be useful for diagnosing SCDS.

scholarly journals Active B12: A Rapid, Automated Assay for Holotranscobalamin on the Abbott AxSYM Analyzer

2008 ◽  
Vol 54 (3) ◽  
pp. 567-573 ◽  
Author(s):  
Jeff Brady ◽  
Lesley Wilson ◽  
Lynda McGregor ◽  
Edward Valente ◽  
Lars Orning
Keyword(s):  
Vitamin B12 ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Reference Interval ◽  
Cross Reactivity ◽  
Total Serum ◽  
Serum Samples ◽  
Automated Assay ◽  
Microparticle Enzyme Immunoassay ◽  
B12 Deficiency

Abstract Background: Conventional tests for vitamin B12 deficiency measure total serum vitamin B12, whereas only that portion of vitamin B12 carried by transcobalamin (holotranscobalamin) is metabolically active. Measurement of holotranscobalamin (holoTC) may be more diagnostically accurate for detecting B12 deficiency that requires therapy. We developed an automated assay for holoTC that can be used on the Abbott AxSYM immunoassay analyzer. Methods: AxSYM Active B12 is a 2-step sandwich microparticle enzyme immunoassay. In step 1, a holoTC-specific antibody immobilized onto latex microparticles captures holoTC in samples of serum or plasma. In step 2, the captured holoTC is detected with a conjugate of alkaline phosphatase and antiTC antibody. Results: Neither apoTC nor haptocorrin exhibited detectable cross-reactivity. The detection limit was ≤0.1 pmol/L. Within-run and total imprecision (CV ranges) were 3.4%–5.1% and 6.3%–8.5%, respectively. Assay CVs were <20% from at least 3 pmol/L to 107 pmol/L. With diluted serum samples, measured concentrations were 104%–114% of the expected values in the working range of the assay. No interference from bilirubin, hemoglobin, triglycerides, erythrocytes, rheumatoid factor, or total protein was detected at expected (abnormal) concentrations. A comparison of the AxSYM Active B12 assay with a commercial RIA for holoTC yielded the regression equation: AxSYM = 0.98RIA + 4.7 pmol/L (Sy x, 11.4 pmol/L; n = 204). Assay throughput was 45 tests/h. A 95% reference interval of 19–134 pmol/L holoTC was established with samples from 292 healthy individuals. Conclusions: The AxSYM Active B12 assay allows rapid, precise, sensitive, specific, and automated measurement of human holoTC in serum and plasma.

Acute Dementia with Delirium Due to Vitamin B12 Deficiency: A Case Report

2002 ◽  
Vol 32 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Vladimir Lerner ◽  
Michael Kanevsky
Keyword(s):  
Case Report ◽  
Psychiatric Patients ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Vitamin B ◽  
State Of Health ◽  
Organic Psychosis ◽  
B12 Deficiency ◽  
Previous State

Objective: Vitamin B12 (cobalamin) is a key component in the catabolism of monoamines. B12 deficiency is associated with various neuropsychiatric disorders and may be more frequent in psychiatric inpatients. The authors describe a case report of a newly admitted and relatively young patient (52 years old) with organic psychosis secondary to vitamin B12 deficiency. No other overt clinical features of cobalamin deficit were observed. Symptoms were resolved with B12 and folate replacement. The patient's mental status remained stable over the 3 months after the treatment. The authors note that organic mental changes were reversible with B12 replacement. Conclusions: The authors propose that determination of serum vitamin B12 and folic acid levels should be recommended as routine screening in all new admissions of psychiatric patients regardless of their age or previous state of health.

scholarly journals Assessment of vitamin B12 deficiency and B12 screening trends for patients on metformin: a retrospective cohort case review

2021 ◽  
pp. bmjnph-2020-000193
Author(s):  
Darby Martin ◽  
Jeet Thaker ◽  
Maria Shreve ◽  
Lois Lamerato ◽  
Kartazyna Budzynska
Keyword(s):  
Retrospective Cohort ◽  
Protective Factor ◽  
Vitamin B12 Deficiency ◽  
Older Age ◽  
Secondary Outcome ◽  
Vitamin B ◽  
Case Review ◽  
Large Hospital ◽  
Hospital System ◽  
B12 Deficiency

ObjectivesOur study investigated the use of vitamin B12 testing in a large cohort of patients on metformin and assesses appropriateness and benefits of screening recommendations for vitamin B12 deficiency.DesignThis retrospective cohort study included insured adult patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin to establish compliance. The comparison group was not exposed to metformin. Primary outcome was incidence of B12 deficiency diagnosed in patients on metformin. Secondary outcome was occurrence of B12 testing in the patient population on metformin. Records dated through 31 December 2018 were analysed.SettingLarge hospital system consisting of inpatient and outpatient data base.ParticipantsA diverse, adult, insured population of patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin.ResultsOf 13 489 patients on metformin, 6051 (44.9%) were tested for vitamin B12 deficiency, of which 202 (3.3%) tested positive (vs 2.2% of comparisons). Average time to test was 990 days. Average time to test positive for deficiency was 1926 days. Factors associated with testing were linked to sex (female, 47.8%), older age (62.79% in patients over 80 years old), race (48.98% white) and causes of malabsorption (7.11%). Multivariable logistic regression showed older age as the only factor associated with vitamin B12 deficiency, whereas African-American ethnicity approached significance as a protective factor.ConclusionsBased on our study’s findings of vitamin B12 deficiency in patients on metformin who are greater than 65 years old and have been using it for over 5 years, we recommend that physicians consider screening in these populations.

scholarly journals Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders

2018 ◽  
Vol 7 (10) ◽  
pp. 304 ◽  
Author(s):  
Emmanuel Andrès ◽  
Abrar-Ahmad Zulfiqar ◽  
Khalid Serraj ◽  
Thomas Vogel ◽  
Georges Kaltenbach
Keyword(s):  
Vitamin B12 ◽  
Prospective Studies ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Cochrane Library ◽  
Clinical Approach ◽  
Oral Vitamin ◽  
Hand Search ◽  
B12 Deficiency

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer’s disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn’s disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.

Vitamin B12 deficiency is the dominant nutritional cause of hyperhomocysteinemia in a folic acid-fortified population

2005 ◽  
Vol 43 (10) ◽  
Author(s):  
Ralph Green ◽  
Joshua W. Miller
Keyword(s):  
United States ◽  
Folic Acid ◽  
Vitamin B12 Deficiency ◽  
The United States ◽  
Community Dwelling ◽  
Vitamin B ◽  
Prevalence Rates ◽  
Total Vitamin ◽  
Folic Acid Fortification ◽  
B12 Deficiency

AbstractPrevalence rates for folate deficiency and hyperhomocysteinemia have been markedly reduced following the introduction of folic acid fortification in the United States. We report the prevalence of hyperhomocysteinemia in a population of community-dwelling elderly Latinos in the post-folic acid fortification era. We measured homocysteine, total vitamin B

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