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      Microcytic Anemia Hiding Vitamin B12 Deficiency Anemia

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          Abstract

          Vitamin B12 is an essential water-soluble vitamin that mediates multiple coenzymes needed for cell synthesis, mainly the red blood cells. Its deficiency is characterized by megaloblastic anemia and neuropsychiatric symptoms. Macrocytosis is the classical picture seen usually, but having microcytosis is unlikely. We report a case series of three cousins with vitamin B12 deficiency who presented with microcytosis.

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          Clinical practice. Vitamin B12 deficiency.

          Sally P. Stabler (2013)
          Article 0 comments Cited 148 times – based on 0 reviews     Review now
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            Vitamin B12 Deficiency: Recognition and Management.

            Andrew J Goodbred, Robert C Langan (2017)
            Vitamin B12 deficiency is a common cause of megaloblastic anemia, various neuropsychiatric symptoms, and other clinical manifestations. Screening average-risk adults for vitamin B12 deficiency is not recommended. Screening may be warranted in patients with one or more risk factors, such as gastric or small intestine resections, inflammatory bowel disease, use of metformin for more than four months, use of proton pump inhibitors or histamine H2 blockers for more than 12 months, vegans or strict vegetarians, and adults older than 75 years. Initial laboratory assessment should include a complete blood count and serum vitamin B12 level. Measurement of serum methylmalonic acid should be used to confirm deficiency in asymptomatic high-risk patients with low-normal levels of vitamin B12. Oral administration of high-dose vitamin B12 (1 to 2 mg daily) is as effective as intramuscular administration for correcting anemia and neurologic symptoms. Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe neurologic symptoms. Absorption rates improve with supplementation; therefore, patients older than 50 years and vegans or strict vegetarians should consume foods fortified with vitamin B12 or take vitamin B12 supplements. Patients who have had bariatric surgery should receive 1 mg of oral vitamin B12 per day indefinitely. Use of vitamin B12 in patients with elevated serum homocysteine levels and cardiovascular disease does not reduce the risk of myocardial infarction or stroke, or alter cognitive decline.
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              Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms.

              Daphna Dror, Adrian Allen (2008)
              Severe vitamin B(12) deficiency produces a cluster of neurological symptoms in infants, including irritability, failure to thrive, apathy, anorexia, and developmental regression, which respond remarkably rapidly to supplementation. The underlying mechanisms may involve delayed myelination or demyelination of nerves; alteration in the S-adenosylmethionine:S-adenosylhomocysteine ratio; imbalance of neurotrophic and neurotoxic cytokines; and/or accumulation of lactate in brain cells. This review summarizes the current knowledge concerning infantile vitamin B(12) deficiency, including a pooled analysis of case studies of infants born to mothers with untreated pernicious anemia or a strict vegetarian lifestyle and a discussion of the mechanisms that may underlie the manifestations of deficiency.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 27 December 2021
                Publication date (Electronic, collection): December 2021
                Volume: 13
                Issue: 12
                Electronic Location Identifier: e20741
                Affiliations
                [1 ] Pediatrics, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, SAU
                [2 ] Ophthalmology, Al Jabr Hospital, Ministry of Health, Al-Ahsa, SAU
                [3 ] Internal Medicine, King Fahad General Hospital, Ministry of Health, Al-Ahsa, SAU
                [4 ] Family Medicine, National Guard Health Affairs, Riyadh, SAU
                [5 ] Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
                [6 ] Pediatric Hematology/Oncology, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, SAU
                Author notes
                Article
                DOI: 10.7759/cureus.20741
                PMC ID: 8791038
                PubMed ID: 35111433
                SO-VID: e2e1da73-5cb9-4bd6-b1d7-c93db7ab2cd0
                Copyright © Copyright © 2021, Busaleh et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 27 December 2021
                Categories
                Subject: Pediatrics
                Subject: Hematology

                Keywords: cobalamin,microcytic anemia,macrocytic anemia,anemia,vitamin b12
                Data availability:
                Keywords: cobalamin, microcytic anemia, macrocytic anemia, anemia, vitamin b12

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