Impaired Response to Iron Dextran Infusion Due to Latent Vitamin B12 Deficiency without Achlorhydria

1968 ◽  
Vol 13 (1) ◽  
pp. 24-26
Author(s):  
J. J. Boyd ◽  
John Bonnar ◽  
R. W. Payne
Keyword(s):  
Hydrochloric Acid ◽  
Iron Deficiency Anaemia ◽  
Vitamin B12 Deficiency ◽  
Severe Anaemia ◽  
Free Hydrochloric Acid ◽  
Vitamin B ◽  
Iron Dextran ◽  
Deficiency Anaemia ◽  
Haematological Response ◽  
B12 Deficiency

A case of severe iron-deficiency anaemia as a result of intractable menorrhagia is described. Following treatment with an iron dextran infusion, an impaired haematological response occurred; this was shown to be the result of vitamin B12 deficiency despite the presence of abundant free hydrochloric acid in the gastric juice. The severe anaemia (3.5 g. %) was corrected within 5 weeks by one iron dextran infusion and vitamin B12 therapy prior to hysterectomy.

scholarly journals Severe Anaemia during Late Pregnancy

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mahenaz Akhtar ◽  
Ismail Hassan
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Late Pregnancy ◽  
Severe Anaemia ◽  
Blood Transfusions ◽  
Deficiency Anaemia ◽  
History Of ◽  
B12 Deficiency ◽  
Folate And Vitamin B12 ◽  
In Pregnancy

Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10–28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb) levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient’s haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

scholarly journals Assessing the Frequency, Investigation, and Management of Post-operative Anaemia in Hip Fracture Patients

2021 ◽  
Author(s):  
David Livingstone McCormack ◽  
Orla Costigan ◽  
Emily McGarry ◽  
Shane O’Hanlon ◽  
Conor Hurson
Keyword(s):  
Hip Fracture ◽  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Vitamin B12 Deficiency ◽  
Folate Deficiency ◽  
University Hospital ◽  
Major Surgery ◽  
Deficiency Anaemia ◽  
Retrospective Audit ◽  
B12 Deficiency

Abstract BackgroundPost-operative anaemia affects up to 90% of patients undergoing major surgery [1]. Post-operative anaemia can contribute to slower rehabilitation, increased morbidity, and increased mortality [2]. AimsWe aimed to examine the frequency, investigation, and management of anaemia in patients admitted to St. Vincent’s University Hospital (SVUH) with a hip fracture.MethodsA retrospective audit, examining all patients who were admitted to SVUH with a hip fracture between the 1st of April and the 30th of June 2020, was performed. ResultsA total of 58 patients were included. Upon admission, 29.3% (n = 17) of patients were anaemic. Post-operatively, 91.4% of patients (n = 53) were anaemic. 43.1% (n = 25) of patients had iron studies, ferritin, folate and B12 levels measured. Iron deficiency anaemia was detected in 22.4% (n = 13) of patients, folate deficiency was detected in 10.3% (n = 6), and no patients were found to have vitamin B12 deficiency. Of the patients with iron deficiency anaemia, 15.4% (n = 2) were given IV iron infusions and 7.7% (n = 1) received a prescription for oral iron. Of the 6 patients with folate deficiency, 33.3% (n = 2) received a prescription for folic acid. Red cell transfusions were given to 13.8% (n = 8) of patients. Upon discharge, 89.7% (n = 52) of patients remained anaemic. ConclusionsAnaemia is an under-investigated and under-treated complication of hip fractures.

scholarly journals ETIOLOGICAL PROFILE OF 50 CASES 0F ANAEMIA IN CKD

2020 ◽  
pp. 1-2
Author(s):  
Yalavarthi Hema Choudary ◽  
E. Karthik ◽  
Ch. Sudhakar
Keyword(s):  
Chronic Disease ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Clinical Examination ◽  
Iron Deficiency Anaemia ◽  
Vitamin B12 Deficiency ◽  
Deficiency Anaemia ◽  
Anaemia Of Chronic Disease ◽  
B12 Deficiency ◽  
Erythropoietin Deficiency

Background and objectives: Anaemia is a common and significant complication of chronic kidney disease (CKD). When present it may cause symptoms such as fatigue and shortness of breath. It is associated with reduced quality of life and increased cardiovascular disease, hospitalizations, cognitive impairment and mortality. As kidney disease progresses, anaemia increases in prevalence affecting nearly all patients with stage V CKD. In patients with CKD, anaemia is defined as the situation in which the concentration of haemoglobin (Hb) in the blood is below 2 times the SD of the mean Hb of the general population. As the pathogenesis of anaemia in CKD is mutlifactorial, this study is intended to know various etiological factors responsible for anaemia in CKD patients. Methods: 50 patients who met with inclusion criteria and exclusion criteria are subjected to detail clinical examination and investigations. Depending upon data obtained, results are evaluated and the percentage of various types of anaemia in CKD was calculated. Results: At the end of study, anaemia of chronic disease (60%) constitutes the commonest cause of anaemia in CKD, followed by iron deficiency anaemia (30%) and megaloblastic anaemia (10%) due to vitamin B12 deficiency. Conclusion: Among 50 cases of anaemia in CKD, anaemia of chronic disease due to erythropoietin deficiency was the most common cause followed by iron deficiency anaemia. Usually clinical examination and routine simple investigations will clinch the diagnosis in most of the cases.

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.

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

Ileocaecal tuberculosis: an under-recognised cause of vitamin B12 deficiency

2018 ◽  
Vol 49 (2) ◽  
pp. 143-144
Author(s):  
Ashok Kumar Pannu ◽  
Dinesh Raja Palanisamy
Keyword(s):  
Terminal Ileum ◽  
Vitamin B12 Deficiency ◽  
Abdominal Tuberculosis ◽  
Megaloblastic Anaemia ◽  
Vitamin B ◽  
Lower Quadrant ◽  
Abdominal Tenderness ◽  
B12 Deficiency ◽  
Clinical Triad ◽  
Right Lower Quadrant

A combination of anaemia and knuckle pigmentation should always raise concern for megaloblastic anaemia. As the terminal ileum is the site of vitamin B12 absorption and also the commonest site of abdominal tuberculosis, a clinical triad of prolonged fever, knuckle pigmentation and right lower quadrant abdominal tenderness should suggest ileocaecal tuberculosis in endemic areas.

scholarly journals Systematic review to investigate the safety of induction and augmentation of labour among pregnant women with iron-deficiency anaemia

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021793 ◽  
Author(s):  
Kathryn Bunch ◽  
Nia Roberts ◽  
Marian Knight ◽  
Manisha Nair
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Case Reports ◽  
Case Series ◽  
Severe Anaemia ◽  
Risk Of Bias ◽  
Deficiency Anaemia ◽  
Increased Risk

ObjectiveTo conduct a systematic review to investigate the safety of induction and/or augmentation of labour compared with spontaneous-onset normal labour among pregnant women with iron-deficiency anaemia.DesignSystematic review.SettingStudies from all countries, worldwide.PopulationPregnant women with iron-deficiency anaemia at labour and delivery.InterventionAny intervention related to induction and/or augmentation of labour.Outcome measuresPrimary: Postpartum haemorrhage (PPH), heart failure and maternal death. Secondary: Emergency caesarean section, hysterectomy, admission to intensive care unit.MethodWe searched 10 databases, including Medline and Embase, from database inception to 1 October 2018. We included all study designs except cross-sectional studies without a comparator group, case reports, case series, ecological studies, and expert opinion. The searches were conducted by a healthcare librarian and two authors independently screened and reviewed the studies. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approachto ascertain risk of bias and conducted a narrative synthesis.ResultsWe identified 3217 journal articles, 223 conference papers, 45 dissertations and 218 registered trials. Ten articles were included for full-text review and only one was found to fulfil the eligibility criteria. This was a retrospective cohort study from India, which showed that pregnant women with moderate and severe anaemia could have an increased risk of PPH if they underwent induction and/or augmentation of labour, but the evidence was weak (graded as ‘high risk of bias’).ConclusionThe best approach is to prevent anaemia, but a large number of women in low-to-middle-income countries present with severe anaemia during labour. In such women, appropriate peripartum management could prevent complications and death. Our review showed that at present we do not know if induction and augmentation of labour is safe in pregnant women with iron-deficiency anaemia and further research is required.PROSPERO registration numberCRD42015032421.

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