Recognition and management of vitamin B12 deficiency: Report of four cases with oral manifestations

Vitamin B12, also known as cobalamin is a water soluble vitamin. It is critical for normal functioning of the red blood cell formation and nervous system. It is a complex vitamin and it’s deficiency is known to be one of the commonest deficiency in Indian population particularly in elderly and in vegans as it requires castles intrinsic factor released by parietal cells in the stomach for its absorption. Vitamin B12 deficiency may also result from pernicious anemia, gastrectomy & intestinal malabsorption. It is often overlooked and may cause several oral, haematological, gastrointestinal, psychiatric and neurological manifestations. As it affects the oral mucosal tissues, early diagnosis of the manifestations may aid in diagnosing the underlying cause even before haematological examination. Hence, oral physicians should be vigilant enough to identify signs or symptoms of suspected vitamin deficiency in populations at risk. Early diagnosis is crucial for starting replacement therapy to avoid irreversible neurological damage. This article reviews the various oral manifestations of vitamin B12 deficiency and its management.

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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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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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