Review of oral vitamin B12 (cobalamin) therapy

2016 ◽  
Vol 2 (11) ◽  
Author(s):  
Emmanuel Andrès
Keyword(s):  
Vitamin B12 ◽  
Marked Improvement ◽  
Reticulocyte Count ◽  
Hematological Parameters ◽  
Serum Vitamin ◽  
Hemoglobin Level ◽  
Cobalamin Deficiency ◽  
Neurological Manifestations ◽  
Oral Vitamin ◽  
Prospective Cohort Studies

<p>Vitamin B12 (cobalamin) deficiency is particularly common in adults and elderlies (&gt;15%). Management of cobalamin deficiency with cobalamin injections is currently well codified, but new routes of vitamin B12 administration (oral and nasal) are being studied, especially oral vitamin B12 therapy for food-cobalamin malabsorption. Three prospective randomized studies, a systematic review by the <em>Cochrane</em> group and five prospective cohort studies were found and provide evidence that oral vitamin B12 treatment may adequately treat cobalamin deficiency. The efficacy was particularly highlighted when looking at the marked improvement in serum vitamin B12 levels and hematological parameters, for example hemoglobin level, mean erythrocyte cell volume, reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. Oral cobalamin treatment <ins cite="mailto:Nosaltres" datetime="2007-02-07T00:39">avoid</ins>s<ins cite="mailto:Nosaltres" datetime="2007-02-07T00:39"> the discomfort, inconvenience and cost of monthly injections</ins>.</p>

scholarly journals Study of vitamin B12 status and the consequential clinico-hematological profile in healthy vegetarian population in Nepal

2017 ◽  
Vol 7 (1) ◽  
pp. 41-46
Author(s):  
Pramod Paudel ◽  
Jagdish Prasad Agrawal ◽  
Santosh Timilsena ◽  
Jyoti Subedi
Keyword(s):  
Vitamin B12 ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Hemoglobin Level ◽  
Cobalamin Deficiency ◽  
P Value ◽  
Hematological Profile ◽  
Significant Difference ◽  
B12 Deficiency ◽  
Study Population

Background: A strict vegetarian diet has been associated with an increased risk of vitamin B12 deficiency. Clinical manifestations of cobalamin deficiency are hematologic and neurological symptoms. The purpose of this study was to determine the prevalence of vitamin B12 deficiency in healthy vegetarian population and to study the clinical and hematological profile of vitamin B12 deficient subjects.Methods: A community based cross-sectional observational study was conducted through preplanned camps in Kathmandu Nepal. 166 vegetarian people were investigated for serum vitamin B12 level and their hematological profile was done. They were examined for neurological manifestation of vitamin B12 deficiency.Results: The mean serum vitamin B12 level of the vegetarian in this study was 271.34 ±241.74 pg/ml (mean ± SD)., 53.6 % had serum vitamin B12 deficiency. 56.5 % of male and 47.1 % of female had vitamin B12 deficiency. The risk of vitamin B12 deficiency is more in males than females with odds ratio 1.201 (CI=95%) which is not statistically significant with p-value 0.312. There was no significant difference in vitamin B12 level in different age group.The study population had mean hemoglobin of 13.12 ± 1.72 gm/dl. Anemia was present in 34.9 % of study population. 33.9 % of male and 37.3 % of female had anemia. There was no significant difference in anemia in male and female vegetarian (p-value 0.72). 40% of patient who had vitamin B12 deficiency had anemia.A significant low hemoglobin level and higher MCV were found as level of serum vitamin B12 decreased. Only one patient had macrocytic anemia.There were few symptoms but not specific to vitamin B12 deficiency.Conclusion: The result of present study show that prevalence of vitamin B12 deficiency among healthy vegetarian was 53.6% with higher prevalence in male and elder age group.Prevalence of anemia was 34.9% in this study with elderly group and females being more affected.There was significant correlation between vitamin B12 and hemoglobin level and significant negative correlation with MCV. Although, not significant, leucocytes count, lymphocyte count and platelets were low in vitamin B12 deficient population.Few clinical features were present in vitamin B12 deficient subjects but neurological features specific to vitamin B12 deficiency were not seen.

scholarly journals Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

2019 ◽  
Vol 6 (2) ◽  
pp. 489
Author(s):  
Nalina Thimmappa ◽  
Vijeth S. B. ◽  
Prashanth G. ◽  
Sreedevi B. K.
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Biochemical Parameters ◽  
Reticulocyte Count ◽  
Megaloblastic Anemia ◽  
Hematological Parameters ◽  
Macrocytic Anemia ◽  
Serum Vitamin ◽  
Systematic Evaluation ◽  
Significant Difference

Background: Macrocytosis can be seen in many hematological and non-hematological disorders and more than one cause may co-exist in an individual. Serum vitamin B12 and folic acid tests are routinely ordered but they are limited by their low sensitivity and specificity. This study is done to analyze the clinical, hematological and biochemical parameters in macrocytic anemia and to study the difference between megaloblastic and non-megaloblastic anemia in these parameters.Methods: There were 100 patients presenting with macrocytosis were taken in to study. A detailed clinical history and physical examination was done in all cases. CBC, biochemical investigations, peripheral blood examination, Vitamin B12, folate levels, bone marrow aspiration and reticulocyte count was done in all cases.Results: Primary bone marrow disorders were the most common cause of macrocytosis (45%). The other causes in decreasing order of frequency were megaloblastic anemia (36%), alcoholism and liver disease (15%), drug induced (2%) and idiopathic thrombocytopenic purpura (1%). There was a significant difference in the mean values of MCV and serum LDH between megaloblastic and non-megaloblastic macrocytosis. When serum LDH >1124.5IU/L or MCV>120.5fl (criterion values of ROC curve) with reticulocyte count <2% was taken as criteria, the sensitivity was 94.4% and specificity was 93% for diagnosing megaloblastic anemia.Conclusions: Systematic evaluation of macrocytosis will help us to distinguish megaloblastic and non-megaloblastic macrocytosis. The blood and biochemical parameters especially CBC, RC, and serum LDH along with supporting clinical features help us in diagnosing megaloblastic anemia in a setup where vitamin and metabolite levels are difficult to obtain.

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.

scholarly journals Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

2018 ◽  
Vol 7 (2) ◽  
pp. 309 ◽  
Author(s):  
Shailendra D. ◽  
Rizwan Kalani ◽  
K. M. Venkat Narayan ◽  
Dorairaj Prabhakaran ◽  
Nikhil Tandon ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Rural Community ◽  
Odds Ratio ◽  
Complete Blood Count ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Oral Vitamin ◽  
South Indian ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.

scholarly journals COBALAMIN DEFICIENCY IN THE ELDERLY

2020 ◽  
Vol 12 (1) ◽  
pp. e2020043 ◽  
Author(s):  
Giacomo Marchi ◽  
Fabiana Busti ◽  
Acaynne Lira Zidanes ◽  
Alice Vianello ◽  
Domenico Girelli
Keyword(s):  
Vitamin B12 ◽  
Early Recognition ◽  
Bone Marrow Failure ◽  
Oral Treatment ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Cobalamin Deficiency ◽  
High Dose

Older people are at risk for cobalamin (vitamin B12) deficiency because of a number of common disorders (e.g. autoimmune gastritis) and drugs (e.g. antacids) that may alter its absorption and utilization. The prevalence of cobalamin deficiency increases with age, resulting particularly elevated in frail and institutionalized subjects. At variance with common sense, the diagnosis is far from simple and requires a high degree of suspicion, due to heterogeneity and non-specificity of the signs and symptoms, ranging from macrocytosis (with or without anemia) to neuropsychiatric manifestations, that characterize several other aging-related disorders, like hematological malignancies, diabetes, hypothyroidism or vasculopathies. Furthermore, the detection of low levels of serum vitamin B12 appears poorly sensitive and specific. Other biomarkers, like serum homocysteine or methylmalonic acid, have improved the diagnostic possibilities but are expensive, not widely available and may be influenced by some confounders (e.g. folate deficiency, or chronic renal failure). Early recognition and treatment are crucial, since a proportion of patients develop severe complications, such as bone marrow failure and irreversible neurological impairment. High-dose oral treatment has proven to be as effective as the parenteral route even in subjects with malabsorption, ensuring the complete resolution in the majority of cases. In this review, we trace the essential role of cobalamin in humans, the possible causes and impact of deficiency, the diagnostic challenges and the therapeutic options, between old and emerging concepts, with a particular focus on the elderly.

scholarly journals State of the art review: oral and nasal vitamin B12 therapy in the elderly

QJM ◽  
2019 ◽  
Vol 113 (1) ◽  
pp. 5-15
Author(s):  
E Andrès ◽  
A -A Zulfiqar ◽  
T Vogel
Keyword(s):  
Elderly Patients ◽  
Vitamin B12 ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
The Elderly ◽  
Cochrane Library ◽  
Oral Vitamin ◽  
Hand Search ◽  
Noticeable Improvement ◽  
Google Search

Summary The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by ‘PubMed’ and ‘Scholar Google’ search from January 2010 to July 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 retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from ‘CARE B12’ research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.

scholarly journals vitamin B12 status among anaemic adolescents

2017 ◽  
Vol 4 (5) ◽  
pp. 1780 ◽  
Author(s):  
Amita Surana ◽  
Sandeep Tilwani ◽  
Shefali Patel ◽  
Hiren Prajapati ◽  
Rajeev Prasad
Keyword(s):  
Vitamin B12 ◽  
Sex Education ◽  
Hematological Parameters ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Cross Sectional ◽  
Dietary History ◽  
Rbc Indices ◽  
B12 Deficiency ◽  
Severe Degree

Background: Nutritional anaemia are common health problems. Most studies are done regarding iron deficiency anaemias. There are limited data regarding vitamin B12 deficiency anaemia especially in adolescents. Aims and objectives of the study were to find the prevalence of vitamin B12 deficiency among anaemic adolescents and to study various socio-demographic factors and hematological parameters associated with vitamin B12 deficiency. Methods: Cross sectional hospital based observational study of 211 adolescents (10 -18 year) with anaemia. Socio demographic characteristics like age, sex, education of mother & patient, socio- economic class, dietary history were noted for each patient. CBC including RBC indices and serum estimation of vitamin B12 level were done for each patient. Results: Anaemia was seen in 46.6% of adolescents. Vitamin B12 deficiency was seen in 49.76%. Vitamin B12 deficiency was significantly associated with male gender (p=0.032) and vegetarians (p=0.047). Moderate to severe degree of anaemia (p=0.016), macrocytosis (p= 0.000) and thrombocytopenia (p=0.007) was more observed in vitamin B12 deficient patients as compared to vitamin B12 non deficient groups. Statistically significant fall in mean haemoglobin level and increase in mean MCV values were seen with decreasing serum vitamin B12 level. Conclusions: Among anemic male and vegetarian adolescents vitamin B12 deficiency is a significant health problem. Hematological findings in peripheral blood are more associated with severe degree of vitamin B12 deficiency. Vitamin B12 supplementation along with IFA should be addressed through national programmes.  

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