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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 3  |  Page : 244-246

Vitamin B12 deficiency without anemia in the middle- and old-aged population in Sulaymaniyah City


Department of Pathology, College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq, India

Date of Submission07-Feb-2020
Date of Acceptance07-Jun-2020
Date of Web Publication16-Sep-2020

Correspondence Address:
Hisham Arif Getta
Department of Pathology, College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_71_19

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  Abstract 


Background: In our laboratory, we received many cases of Vitamin B12 deficiency without anemia, and we observed that the deficiency is more prominent in females than males. It is well known that Vitamin B12 deficiency is usually associated with macrocytic anemia. However, the clinical importance of Vitamin B12 insufficiency without any hematological abnormality is underestimated in the Sulaymaniyah city population. Thus, the aim of this study is to assess the frequency of Vitamin B12 deficiency with normal complete blood counts (CBCs), especially in the middle- and old-aged population. Materials and Methods: Within the period from April 2018 to April 2019, the patients came to the Dr. Hisham Alrawi Private Laboratory for Vitamin B12 level estimation; the CBCs for all patients with Vitamin B12 deficiency have been collected. We selected patients with low-level Vitamin B12, which were 149 patients, aged 30 years and above. Normal serum Vitamin B12 value in our laboratory is 191–633 pg/ml according to the e411 Roche competitive-binding luminescence immunoassay system. CBC has been collected were done for all patients with Vitamin B12 deficiency by Orphee Mythic 18 Hematology Analyzer. Results: The mean of their age is 64 years, and the mean of hemoglobin (Hb) level is 12.1 g/dL, whereas the mean of Vitamin B12 level is 131.3 pg/ml. About 74 (49.6%) of them have anemia, and 75 (51.4%) are with the normal CBC parameters. The mean of the Hb in females is with the normal range (12.1 g/dL), whereas the mean of the Hb in the males is lower than the normal range (12 g/dL). Conclusions: Vitamin B12 deficiency is common in middle and old age in Sulaymaniyah city, especially in females. Thus, screening programs for B12 levels estimation for this age group are recommended to avoid expected complications.

Keywords: Anemia, blood analysis, Sulaymaniyah city, Vitamin B12


How to cite this article:
Getta HA. Vitamin B12 deficiency without anemia in the middle- and old-aged population in Sulaymaniyah City. Med J Babylon 2020;17:244-6

How to cite this URL:
Getta HA. Vitamin B12 deficiency without anemia in the middle- and old-aged population in Sulaymaniyah City. Med J Babylon [serial online] 2020 [cited 2020 Oct 1];17:244-6. Available from: http://www.medjbabylon.org/text.asp?2020/17/3/244/295146




  Introduction Top


Vitamin B12 (cobalamin) is essential for protein synthesis, cell proliferation, and optimal systemic function, particularly for the nervous system and blood. Moderate Vitamin B12 deficiency is common even with the normal hematological parameters.[1] Vitamin B12 is obtained only from a dietary source, and it is an essential vitamin for DNA synthesis in the body.[2]

The main causes of cobalamin deficiency are food-cobalamin malabsorption (53%), pernicious anemia (33%), insufficient nutritional Vitamin B12 intake (2%), and postsurgical malabsorption (1%).[3] Vitamin B12 deficiency is well known as a cause of megaloblastic anemia and peripheral neuropathy, especially in the elderly patients.[4]

Several studies showed that 3%–5% of the population has a Vitamin B12 deficiency. Sometimes, peripheral neuropathy symptoms may appear before megaloblastic anemia, and the frequency of this medical problem is not estimated well in the Sulaymaniyah city population whether at middle or old age.[5]

The total Vitamin B12 measurement is still the method of choice for Vitamin B12 deficiency evaluation in spite of limitations in the sensitivity and specificity for this test. Clinical signs of Vitamin B12 deficiency can be seen in people with Vitamin B12 concentrations within the reference range.[6]

In general, there are a significant number of cases with Vitamin B12 deficiency with normal complete blood count (CBC), especially in females.[7] For that purpose, we designed this study to estimate the Vitamin B12 deficiency of these cases which might be helpful to increase the awareness of the physicians and the neurologists in this city about the importance of early diagnosis of Vitamin B12 deficiency to avoid any complications that may be hard to deal with in the late diagnosis, althoughholoTC concentration for B12 deficiency estimation is not available in our laboratory, which is considered as the earliest marker for B12 store deficiency.


  Materials and Methods Top


Study design

In our laboratory, we have observed a significant number of cases with Vitamin B12 deficiency with normal CBC, especially in females; thus, we reviewed all the results of Vitamin B12 tests which were ordered for patients in our laboratory from April 2018 to April 2019, and we selected patients with low-level Vitamin B12. Normal serum Vitamin B12 value in our laboratory is 191–633 pg/ml according to the e411 Roche competitive-binding luminescence immunoassay system.[8] CBC has been done for all patients with Vitamin B12 deficiency by Orphee Mythic 18 Hematology Analyzer (ORPHEE MEDICAL, Przeźmierowo, Poland).

Ethical consideration

The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki. It was carried out with patients' verbal and analytical approval before the sample was taken. The study protocol and the subject information and consent form were reviewed and approved by a local ethics committee.

Statistical analysis

The data were automatically analyzed by the machines, and we only used Microsoft Excel to determine the percentages.


  Results Top


During this study, a total of 149 patients with Vitamin B12 deficiency have been selected, and CBC was done for all of them. The mean of their age is 64 years, and the mean of hemoglobin (Hb) level was 12.1 g/dL, whereas the mean of Vitamin B12 level was 131.3 pg/ml [Table 1]. The mean of the Hb in females was with the normal range 12.1 g/dL [Table 2], whereas the mean of the Hb in males was lower than the normal range, 12 g/dL [Table 3]. We found that 74 (49.6%) of them were with anemia, and 75 (51.4%) were with the normal CBC parameters. The statistical correlation between anemic patients and non anemic patients with B12 deficiency is also shown in [Table 4].
Table 1: Analyzed data for hematological parameters and Vitamin B12 in selected patients

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Table 2: Analyzed data for hematological parameters and Vitamin B12 in female patients

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Table 3: Analyzed data for hematological parameters and Vitamin B12 in male patients

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Table 4: Shows significant correlation between the anemic patients and non anemic patients with B12 deficiency

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  Discussion Top


The majority of Vitamin B12 deficient patients with anemia were female in middle- to old-aged patient group. The worldwide prevalence of Vitamin B12 deficiency is not certainly known.[9] The prevalence is also not known in our locality, but this study shows that Vitamin B12 deficiency is common, especially without anemia. The mean of the age in the males in this study is higher than females, and this difference could explain that the higher frequency of anemia in females is due to the age rather than the Vitamin B12 deficiency. The mean corpuscular volume value in the anemic patients in this study was within the normal range, and this is another indication that the anemia is mostly due to aging or due to the systemic illness rather than the Vitamin B12 deficiency. With absence of anemia and probably other symptoms in a significant number of patients with Vitamin B12 deficiency as shown in this study and others, the question which needs to be answered here and in other places is whether we need to do a screening program for Vitamin B12 deficiency for middle- and old age groups, especially for females as far as the frequency of anemia is low. Currently, there are no published screening asymptomatic adult guidelines for Vitamin B12 deficiency.[10]


  Conclusions Top


This is the first study to address the associated Vitamin B12 deficiency in Sulaymaniyah City, Northern Iraq, with the mean range of 131.3 pg/ml. The study demonstrated that the prevalence of Vitamin B12 deficiency in females is associated with normal Hb level, whereas associated with abnormal levels of Hb in males.

Recommendation

According to this study, the Vitamin B12 estimation screening program for middle- and old-aged females is recommended for early detection to avoid many Vitamin B12 deficiency-related sequels that may occur in this asymptomatic group. This screening program may be extended to all of the results which show a significant number of asymptomatic patients with Vitamin B12 deficiency, especially for old age.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al-Momen AK, AL-Aqeel AA, Aseeri MA, Al-Fawaz KA, Al-Molhem A, Hasanato RM. Vitamin B12 Deficiency In Patients With Normal Blood Count. Blood 2013;122:55945598.  Back to cited text no. 1
    
2.
Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annu Rev Nutr 1999;19:357-77.  Back to cited text no. 2
    
3.
Carmel R. Current concepts in cobalamin deficiency. Annual Rev Med 2000;51:357-75.  Back to cited text no. 3
    
4.
Atilla KA, Eliacik E, Buyukasik Y, Osman I. Vitamin B12 deficiency with the absence of anemia in young and middle-aged population. Int J Hematol Oncol 2014;3:190-4.  Back to cited text no. 4
    
5.
Ahmed MA, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. BMC Pharmacol Toxicol 2016;17:44.  Back to cited text no. 5
    
6.
Herrmann W, Obeid R. Causes and early diagnosis of Vitamin B12 deficiency. Dtsch Arztebl Int 2008;105:680-5.  Back to cited text no. 6
    
7.
de Benoist B. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food and Nutrition Bulletin 2008;29 suppl1:S238-44.  Back to cited text no. 7
    
8.
Boven LA, van Wijnen M. False normal vitamin B12 levels caused by assay error. Blood 2011;118:492.  Back to cited text no. 8
    
9.
Niafar M, Hai F, Porhomayon J, Nader ND. The role of metformin on vitamin B12 deficiency: A meta-analysis review. Intern Emerg Med 2015;10:93-102.  Back to cited text no. 9
    
10.
Stabler SP. Vitamin B12 deficiency. New England Journal of Medicine 2013;368:149-60.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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