scholarly journals P-OGC11 Vitamin B12 supplementation post gastrectomy. A service audit in St. James’s hospital, Dublin

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Hugo Temperley ◽  
Cian Murray ◽  
James Carey ◽  
Jarlath Bolger ◽  
Narayanasamy Ravi ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Total Gastrectomy ◽  
Cell Mass ◽  
Subtotal Gastrectomy ◽  
Vitamin B12 Deficiency ◽  
Patient Understanding ◽  
Phone Calls ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Abstract Background Vitamin B12 deficiency is a well described complication post gastrectomy. It is caused by the loss of parietal cell mass leading to megaloblastic anaemia and possible long term neurological symptoms. Treatment can be with standardised replacement regimens or to monitor B12 levels and replace as required.  This study assesses patient understanding of and compliance with B12 supplementation guidelines post total and subtotal gastrectomy.  Methods 125 patients who underwent gastrectomy between 2010-2020 were available for study (86 total gastrectomies, 39 subtotal gastrectomies).  Patient data was collected by review of the hospital electronic records and individual phone calls. Patients were asked standardised questions to elicit knowledge of the importance of B12 supplementation and compliance with supplementation. Results 92% (79/86) of total gastrectomy patients reported compliance in regular parenteral B12 supplementation.  Compliance was significantly lower for subtotal gastrectomies  for checking and/or replacing their vitamin B12 at 53.8% (21/39) (p < 0.001). 62.6% of patients stated that they knew it was important to supplement B12 post gastrectomy.  37.8% of participants could explain why this was important and 14.8% had any knowledge of the complications of vitamin B12 deficiency. Patients who were compliant with B12 supplementation had an improved understanding of why supplementation was important compared to those who did not. Conclusions Regular monitoring and supplementation of vitamin B12 levels is important post gastrectomy.  This study demonstrates good compliance in those undergoing total gastrectomy.  Patient understanding correlates with compliance, suggesting that patient education and knowledge reinforcement may be key to compliance with vitamin B12 supplementation.

Enteral Vitamin B12 Supplementation Is Effective for Improving Anemia in Patients Who Underwent Total Gastrectomy

Oncology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Tsutomu Namikawa ◽  
Masahiro Maeda ◽  
Keiichiro Yokota ◽  
Jun Iwabu ◽  
Masaya Munekage ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Vitamin B12 ◽  
Total Gastrectomy ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Kochi Medical School ◽  
B12 Deficiency ◽  
Red Blood Cell Count ◽  
Baseline Characteristics ◽  
Vitamin B12 Supplementation

Background: This study aimed to investigate the efficacy of enteral supplementation of vitamin B12 for vitamin B12 deficiency in patients who underwent total gastrectomy for gastric cancer. Methods: The study enrolled 133 patients who underwent total gastrectomy for gastric cancer at Kochi Medical School. Clinical data were obtained to investigate associations between vitamin B12 supplementation and vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 less than 200 pg/mL. Baseline characteristics and changes in hematological variables, including vitamin B12 levels, were examined. Results: Vitamin B12 deficiency was present in 71.4% of the 133 patients. Vitamin B12 levels at 3, 6, and 12 months after enteral supplementation were 306 pg/mL, 294 pg/mL, and 367 pg/mL, respectively, which were all significantly higher than those before supplementation (p < 0.001 for all comparisons). The median red blood cell count at 3, 6, and 12 months after enteral supplementation were 380 × 104/mm3, 394 × 104/mm3, and 395 × 104/mm3, respectively, which were all significantly higher than those before supplementation (p = 0.020, p = 0.001, and p = 0.003, respectively). Vitamin B12 levels at 3, 6, and 12 months after supplementation were significantly higher in patients supplemented enterally than those supplemented parenterally (p < 0.001 for all comparisons). Conclusions: Vitamin B12 deficiency was found in 71.4% of postoperative patients who underwent total gastrectomy for gastric cancer, and enteral vitamin B12 supplements might be effective to improve anemia in these patients.

scholarly journals Funicular Myelosis in a Butcher: It Was the Cream Cans

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Fabian Wolpert ◽  
Krisztina Baráth ◽  
Janis Brakowski ◽  
Roland Renzel ◽  
Michael Linnebank ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Diagnostic Process ◽  
Long Term Effects ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation ◽  
Nutritional Vitamin

Background. Funicular myelosis is a known consequence of exposure to nitrous oxide. Nevertheless, there are only a few clinical trials assessing its long-term effects and there is no literature about the role of nutritional vitamin B12 supplementation in the context of nitrous oxide abuse.Case Descriptions. We diagnosed funicular myelosis in a young butcher, who consumed high amounts of meat regularly. Since the diagnostic process did not reveal any metabolic causes, reinterrogation of the patient uncovered recreational abuse of nitrous oxide out of whipped cream can gas cartridges. After stopping abuse and supplementation of vitamin B12, the patient recovered almost completely.Conclusions. In our case, even high nutritional vitamin B12 uptake could not compensate the noxious effects of nitrous oxide. Since there are emerging reports of increasing misuse, this should be considered in the diagnostic and therapeutic care of patients with nitrous oxide abuse. Furthermore, our case emphasizes that patients with vitamin B12 deficiency should be assessed for nitrous oxide abuse.

scholarly journals Microangiopathic haemolytic anaemia with thrombocytopenia induced by vitamin B12 deficiency long term after gastrectomy

2018 ◽  
pp. bcr-2018-225915 ◽  
Author(s):  
Yukinori Harada ◽  
Itsumi Komori ◽  
Kouhei Morinaga ◽  
Taro Shimizu
Keyword(s):  
Vitamin B12 ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Haemolytic Anaemia ◽  
Vitamin B12 Deficiency ◽  
Rapid Progression ◽  
Thrombocytopenic Purpura ◽  
Microangiopathic Haemolytic Anaemia ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Microangiopathic haemolytic anaemia with thrombocytopenia, called pseudo-thrombotic microangiopathy (TMA), is a clinically important complication in patients with vitamin B12 deficiency. We herein present a case of an 80-year-old woman with pseudo-TMA after gastrectomy. She was initially suspected with thrombotic thrombocytopenic purpura based on rapid progression of anaemia with schistocytes and thrombocytopenia; however, her anaemia and thrombocytopenia were improved by vitamin B12 supplementation alone, with a single session of plasma exchange. Vitamin B12 deficiency was finally confirmed by low vitamin B12 levels from the patient’s initial blood sample. In addition, normal ADAMTS13 activity was proven, lowering the likelihood of thrombotic thrombocytopenic purpura. Therefore, this patient was diagnosed with pseudo-TMA caused by vitamin B12 deficiency. Pseudo-TMA can occur in patients with vitamin B12 deficiency post-gastrectomy.

Vitamin B12 Deficiency an Unusual Cause of Fever: A Case Report

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
Shyama . ◽  
P. Kumar ◽  
Surabhi .
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Unusual Case ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Aspiration ◽  
Microcytic Anemia ◽  
Peripheral Smear ◽  
Erythroid Hyperplasia ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Introduction: An unusual case of a 19 year old female, presenting with fever, pallor and hepatosplenomegaly for one month. She had microcytic anemia on peripheral smear examination but her bone marrow aspiration & biopsy revealed a hypercelluar marrow with megaloblastic erythroid hyperplasia. Resolution of fever within 48 hours of Vitamin B12 supplementation, initiated in view of the megaloblastic bone marrow picture & low serumVitamin B12 level, suggests a causal association. Conclusion: Vitamin B12 deficiency seems to be an unusual cause of PUO (Pyrexia of unkown origin) which should be ruled out in every case of PUO.

Analiza obrazu klinicznego niedokrwistości z niedoboru witaminy B12 u dzieci

2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Aleksandra Pankiewicz ◽  
Anna Adamowicz-Salach ◽  
Marek W. Karwacki ◽  
Katarzyna Pawelec ◽  
Katarzyna Albrecht ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Metabolic Pathways ◽  
Essential Role ◽  
Vitamin B12 Deficiency ◽  
Neurological Damage ◽  
Laboratory Findings ◽  
Delay In Diagnosis ◽  
B12 Deficiency ◽  
Late Manifestation

Diagnosis of vitamin B12 deficiency could be difficult due to various and rather unspecific symptoms and often late manifestation in hematological findings. B12 has a crucial role as cofactor of many metabolic pathways and has essential role in many processes such as DNA synthesis, neuron myelination and gluconeogenesis. Blood smear has a huge role in early diagnosis and should be performed. B12 deficiency is not very common, however could be underestimated especially in developing countries. In children main cause of deficiency is exclusively breastfeeding by vitamin B12 depleted mothers. Consequences of low intake in children are more severe than in adults, because of lower liver storage. Early detection and treatment is very important, because long term deficiency could result in persistent neurological damage. Coexistence iron or folate deficiencies could result delay in diagnosis. In this article different manifestation and laboratory findings in group of children with B12 deficiency is described.

scholarly journals Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study

2016 ◽  
Vol 101 (4) ◽  
pp. 1754-1761 ◽  
Author(s):  
Vanita R. Aroda ◽  
Sharon L. Edelstein ◽  
Ronald B. Goldberg ◽  
William C. Knowler ◽  
Santica M. Marcovina ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Vitamin B12 Deficiency ◽  
Diabetes Prevention Program ◽  
Open Label ◽  
Metformin Group ◽  
B12 Deficiency ◽  
Outcomes Study

Abstract Context: Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. Objective: To assess the risk of B12 deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS). Design: Secondary analysis from the DPP/DPPOS. Participants were assigned to the placebo group (PLA) (n = 1082) or the metformin group (MET) (n = 1073) for 3.2 years; subjects in the metformin group received open-label metformin for an additional 9 years. Setting: Twenty-seven study centers in the United States. Patients: DPP eligibility criteria were: elevated fasting glucose, impaired glucose tolerance, and overweight/obesity. The analytic population comprised participants with available stored samples. B12 levels were assessed at 5 years (n = 857, n = 858) and 13 years (n = 756, n = 764) in PLA and MET, respectively. Interventions: Metformin 850 mg twice daily vs placebo (DPP), and open-label metformin in the metformin group (DPPOS). Main Outcome Measures: B12 deficiency, anemia, and peripheral neuropathy. Results: Low B12 (≤ 203 pg/mL) occurred more often in MET than PLA at 5 years (4.3 vs 2.3%; P = .02) but not at 13 years (7.4 vs 5.4%; P = .12). Combined low and borderline-low B12 (≤ 298 pg/mL) was more common in MET at 5 years (19.1 vs 9.5%; P &lt; .01) and 13 years (20.3 vs 15.6%; P = .02). Years of metformin use were associated with increased risk of B12 deficiency (odds ratio, B12 deficiency/year metformin use, 1.13; 95% confidence interval, 1.06–1.20). Anemia prevalence was higher in MET, but did not differ by B12 status. Neuropathy prevalence was higher in MET with low B12 levels. Conclusions: Long-term use of metformin in DPPOS was associated with biochemical B12 deficiency and anemia. Routine testing of vitamin B12 levels in metformin-treated patients should be considered.

Neuropsychological Profiles of Children Following Vitamin B12 Deficiency During Infancy: A Case Series

2016 ◽  
Vol 17 (3) ◽  
pp. 242-253
Author(s):  
M. Greenham ◽  
V. Anderson ◽  
J. Campbell ◽  
P. Monagle ◽  
M.H. Beauchamp
Keyword(s):  
Vitamin B12 ◽  
Case Series ◽  
Vitamin B12 Deficiency ◽  
Brain Maturation ◽  
Attention And Memory ◽  
Long Term Outcomes ◽  
Retrospective Case ◽  
School Aged Children ◽  
B12 Deficiency

Previous studies investigating long-term outcomes in children following vitamin B12 deficiency during infancy have been limited to IQ or clinical observation. This paper seeks to describe comprehensive neuropsychological profiles in a case series of school-aged children who were treated for infantile vitamin B12 deficiency. This was a retrospective case series of seven children who were treated for vitamin B12 deficiency during infancy and aged 5 to 16 years at the time of testing. While most children had age-expected intellectual performance, the distribution of the sample was skewed to the lower end of the normal range. Furthermore, children were found to have impairments in a number of neuropsychological domains, most common were attention and memory, followed by executive function. These results suggest that while neurological symptoms quickly resolve following treatment, these effects on early brain development may disrupt brain maturation and have the potential to impact on later development.

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