Serum Vitamin B12 Eksikliği Olan Çocuklarda Hematolojik Bulgular

Amaç: Vitamin B12 DNA sentezi ve hematopoez için temeldir ve şiddetli eksikliği yalnızca anemiye neden olmaz aynı zamanda trombositopeni ve lökopeniye neden olabilir. Bu çalışmada, vitamin B12 eksikliği ve hematolojik durumlar arasındaki ilişkiye dikkat çekmek istedik. Gereç ve Yöntem: Bu çalışmanın verileri Gaziantep Üniversitesi ayaktan hasta poliklinikleri elektronik veri sisteminden toplanmıştır. 640 çocuk değerlendirildi. Çalışmaya vitamin B12 seviyesi 200 ng/l’den düşük çocuklar dahil edildi. Bulgular: 477 hastada (%74.5) hematolojik anormallik saptanmadı. Anemi 99 (%15,5) hastada, 2 hastada Hb seviyesi 7 gr/dl’den düşüktü, 91 (%14,2) hastada makrositozsuz anemi, 8’inde (%1,3) makrositozlu anemi, 8’inde (%1,3) lokopeni, 22’sinde (%3,4) nötropeni, 9’unda (%1,4) lenfopeni, 6’sında (%0,9) trombositopeni ve 3 (%0,4) hastada pansitopeni saptandı. Korelasyon değerlendirilmesinde vitamin B12 seviyesinin 200 ng/l’den düşük olmasıyla hematolojik parametreler arasında bir ilişki saptanmadı. Sonuç: Bizim sonuçlarımız gösterdi ki vitamin B12 eksikliği saptanan olguların yalnızca %25,5’inde hematolojik anormallik saptandı, en yaygın hematolojik anormallik ise nötropeni ve anemi idi. Vitamin B12 eksikliği olan olgularda vitamin seviyesi ile tam kan sayımı parametreleri arasında ilişki gösterilemedi.

Anahtar Kelimeler:

anemi, Vitamin B12, nötropeni

Hematological Findings in Children with Serum Vitamin B12 Deficiency

Aim: Vitamin B12 is essential for DNA synthesis and hematopoiesis, and its severe deficiency not only causes anemia, but may also result in thrombocytopenia and leucopenia. In this study, we analysed the relationship between hematological status and vitamin B12 deficiency and draw attention to this issue. Material and Method: The data gathered from our institute Gaziantep University Hospital outpatient clinics electronic database. Six hundred forty children were evaluated. The inclusion criteria were child patients with less than 200 ng/l vitamin B12 levels. Results: Four hundred seventy-seven patients (74.5%) had no hematological abnormalities. Anemia was detected in 99 patients (15.5 %), two patients (0.3%) had a Hb-level < 7 g/dl, anemia without macrocytosis in 91 (14.2 %), anemia with macrocytosis in 8 (1.3 %), leucopenia in 8 (1.3 %), neutropenia in 22 (3.4 %), lymphopenia in 9 (1.4 %), thrombocytopenia in 6 (0.9 %), and pancytopenia in 3 patients (0.4 %). An examination of the correlation, there were no correlations between vitamin B12 levels and hematological parameters. Conclusion: Our results showed that hematological abnormalities were detected in only 25.5% of patients with Vitamin B12 deficiency, and anemia and neutropenia were the most common hematological abnormalities. In addition, serum vitamin B12 levels were not significantly correlated with the complete blood count parameters.

Keywords:

Vitamin B12, anemia, , neutropenia,

PDF

___

1-Koc A, Kocyigit A, Soran M, Demir N, Sevinc E, Erel O, et al. High frequency of maternal vitamin B12 deficiency as an important cause of infantile vitamin B12 deficiency in Sanliurfa province of Turkey. Eur J Nutr. 2006; 45: 291-7.
2- Belghith A, Mahjoub S, Ben Romdhane N. Causes of vitamin B12 deficiency. Tunis Med. 2015 Nov;93(11):678-82.
3-Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004; 24: 299-326.
4- Metz J. A high prevalence of biochemical evidence of vitamin B12 or folate deficiency does not translate into a comparable prevalence of anemia. Food Nutr Bull. 2008; 29(2 Suppl): S74-85.
5- B Toprak, Yalcın HZ, Colak A. Vitamin B12 and Folate Deficiency: Should We Use a Different Cutoff Value for Hematologic Disorders? Int J Lab Hematol. 2014; 36(4): 409-14.
6-Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009; 89(suppl): 693S–6S.
7- De Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food and Nutrition Bulletin. 2008; 29: S238–S244.
8- Lubin BH. Reference values in infancy and childhood. In: Nathan DG, Oski FA, eds. Hematology of Infancy and Childhood, 4th ed. Philadelphia: WB Saunders; 1993: 1905-54.
9-Aktas G, Sait M, Tekce H, Uyeturk U, Tekce B, Savlı H. Effects of vitamin B12 treatment on hematological parameters. Acta Medica Anatolia. 2014; 2: 6–8.
10- Campbell CD, Ganesh J, Ficicioglu C. Two newborns with nutritional vitamin B12 deficiency: challenges in newborn screening for vitamin B12 deficiency. Haematologica. 2005; 90(12 Suppl): ECR45.
11-Doyle JJ, Langevin AM, Zipursky A. Nutritional vitamin B12 deficiency in infancy: three case reports and review of the literature. Pediatr Hematol Oncol. 1989; 6: 161–72.
12- Citak FE, Citak EC. Severe vitamin B12 deficiency in a breast fed infant with pancytopenia. J Trop Pediatr. 2011; 57: 69–70.
13-Simsek OP, Gonc N, Gumruk F, Cetin M. A child with vitamin B12 deficiency presenting with pancytopenia and hyperpigmentation. J. Pediatr. Hematol. Oncol. 2004; 26: 834-6.
14-Andrès E, Affenberger S, Zimmer J, Vinzio S, Grosu D, Pistol G et al. Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency. Clin Lab Haematol. 2006; 28: 50–6.
15- Enver A, Mehmet A, Bayram O, Osman O, Karakus YT, Erdogan F. Frequency of hematological findings associated with severe plasma vitamin B12 deficiency in infants and adolescents. Clin Lab. 2014; 60(4): 659-62.
16- Sezer RG, Bozaykut A, Akoglu HA, Ozdemir GN. The Efficacy of Oral Vitamin B12 Replacement for Nutritional Vitamin B12 Deficiency J Pediatr Hematol Oncol. 2018; 40: e69–e72.
17- Colak A, Anil M, Toprak B, Kose E, Ustuner F. B12 vitamin level in children and its relationship with complete blood count parameters. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi 2012; 2(2): 75-9. (in Turkish)
18- Emen B, Ozturk YK, Eren MA, Ozdemir E, Ozturk F, Duzenli E, et al. Retrospective analysis of the correlation of etiological factors with laboratory features in vitamin B12 deficient patients. Tepecik Egit Hast Derg 2013; 23: 19-23. (in Turkish)
19- Jain R, Kapil M, Gupta GN. MCV should not be the only criteria to order vitamin B12 for anemia under evaluation. Open J Gastroenterol. 2012; 2(4): 187-90.
20- Vidja PJ. Diagnostic value of mean corpuscular volume in the detection of vitamin B12 deficiency. Int J Med Sci Public Health. 2017; 6(7): 1155-57.
21- Erkurt MA, Berber I, Nizam I, Kaya E. Etiologic evaluation of 1012 patients admitted with throm bocytopenia. British Journal of Medicine and Medical Research. 2014; 4: 104-13.
22- Gupta RK, Sharma SD, Gupta R. Megaloblastic Anemia: Clinico-hematologic Profile in 50 Children. J Med Science. 2009; 12(2): 49-52.