Elevation of vitamin B12 levels attributed to biopolymer implants - a case report.

Association between the Level of Serum Vitamin B12 and Venous Thromboembolism in African American Population

Elevated vitamin B12 (B12) levels are linked to an increased risk of cancers, including hematological malignancies. This study focuses on the relationship between elevated B12 and myeloproliferative neoplasms (MPNs): Polycythemia Vera (PV), Primary Myelofibrosis (MF), Essential Thrombocytosis (ET), and Chronic Myeloid Leukemia (CML). Elevated B12 in MPNs is believed to arise from increased transcobalamin I (TCI) secretion by proliferating leukocytes, leading to higher serum levels. B12 may serve as a diagnostic and prognostic biomarker for these conditions. However, its sensitivity, specificity, and cutoff levels are unclear. To assess the prevalence of high B12 levels in MPN patients, determine the median levels, identify a diagnostic cutoff, and evaluate the sensitivity and specificity of B12 as a marker. Data were retrieved from the National Center for Cancer Care and Research in Doha, Qatar, for MPN patients from January 2016 to December 2022. A total of 467 patients were included: 232 with CML, 98 with PV, 88 with ET, and 50 with MF. The majority were male (66%) and of Asian origin (56%), with a median age of 48.7 years. CBC results showed median hemoglobin of 9.2 g/dL, WBC count of 73 x 10^3/uL, and platelet count of 531 x 10^3/uL. Elevated B12 levels were found in 95 patients (20%): 71% CML, 14% PV, 10% MF, and 5% ET. Extreme elevations were seen in 59 patients. The mean B12 level decreased from 747.3 ± 686.5 pg/mL before treatment to 397.9 ± 343.7 pg/mL after one year (p=0.01). Median levels were 458 pg/mL (718) before treatment and 301 pg/mL (229) after. In the extreme high B12 group, the mean was 1722 pg/mL before and 677 pg/mL after treatment. Elevated B12 levels are associated with disease activity in CML. However, their role as a reliable marker for disease monitoring remains uncertain, and further studies are needed to confirm their utility for CML progression.

The prognostic value of vitamin B12 blood levels remains controversial. An association between elevated vitamin B12 and mortality has been reported, particularly among elderly patients with cancers and liver or blood diseases. The present study explored the relationship between mortality and elevated vitamin B12 levels in a population of unscheduled inpatients in an internal medicine unit. This retrospective observational analysis was conducted between August 2014 and December 2018. We compared 165 patients with elevated plasma vitamin B12 levels (>600 pmol/l) with a random sample of 165 patients with normal B12 levels who were hospitalized during the same period. Demographic, clinical, and biological characteristics were assessed during hospitalization. The primary endpoint was all-cause death at 1 year. Patients with elevated B12 were younger, with a lower body mass index and lower plasma albumin than those with normal B12 (75 ± 16 years vs 79 ± 13 years, p = 0.047; 23 ± 5 vs 26 ± 7 kg/m2, p < 0.001; and 33 ± 5 vs 35 ± 5 g/l, p < 0.001, respectively). The prevalence of auto-immune disease and referral from an intensive care unit was higher among patients with elevated B12 (11% vs 5%, p = 0.043 and 36% vs 10%, p < 0.001, respectively). After 1 year of follow-up, 64 (39%) patients with elevated B12 had died compared to 43 (26%) patients with normal B12 (p = 0.018). Multivariate analysis using the Cox proportional hazards regression model adjusted for age, gender, body mass index, intensive care unit hospitalization, albumin level, and the presence of solid cancer or autoimmune disease revealed elevated B12 to be associated with a significant risk of death in the first year of follow-up (hazard ratio: 1.71 [1.08-2.7], p = 0.022). Elevated B12 is an early warning indicator of increased short-term mortality, such as independently of age, cancer, or comorbidities, in patients hospitalized in an internal medicine department.

Increased Vitamin B12 levels are associated with mortality in critically ill medical patients

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Homocysteine (Hcy) has a detrimental influence on human neurons, considering that human GBM cells undergo cell death already at D,L-Hcy concentrations in culture medium of 50 μM. This data demonstrate that Hcy is a potent gliotoxic agent capable of inducing the death of human glial cells already at concentrations reached in brain during hyperhomocysteinemia. The one retrospective study found that the serum vitamin B12 level can be used to predict survival time in metastatic cancer patients including neurological cancer. Cancer risk increases with elevated vitamin B12 level, mostly within the first year of the follow-up period, suggesting that vitamin B12 level could be used as a cancer diagnostic marker. In addition, the relationship between elevated vitamin B12 level and poor cancer survival time has been reported. Previous investigation suggests that the folate supplementation could be used as an adjuvant in antiglioma therapy to limit the low DNA methylation level because this confers a poor prognosis in glioblastoma multiforme patients. Taking into account all presented data, it can be concluded that effect of homocystein, folic acid and vitamin B12 on formation, development and outcome of treatment in patients with carcinoma is very intriguing question, whose response requires additional both experimental and clinical research. There lack of data in the literature on the incidence of elevated levels of Hcy in the blood, as well as the disorders of folic acid and vitamin B12, at malignant tumors of the brain.

Introduction: Vitamin B12 deficiency is a well-known cause of neurologic symptoms, prompting routine measurement in patients with neurologic conditions. However, elevated B12 levels are also observed in some cases. Recent studies suggest a potential link between high B12 levels and neurologic or neurodevelopmental disorders. This study aims to evaluate vitamin B12 levels in children with neurologic disorders compared with those in general pediatric populations. Materials and Methods: This single-center retrospective study analyzed pediatric patients' vitamin B12 levels between 2000 and 2023. Exclusion criteria included incomplete data and vitamin supplementation. Patients were grouped based on B12 levels (<200 pg/mL, 201-660 pg/mL, 661-1000 pg/mL, > 1000 pg/mL). Age, gender, and diagnoses were assessed, focusing on patients with elevated B12 levels (>660 pg/mL) in the neurology clinic. Vitamin B12 levels were measured using Roche Cobas e 601 analyzers. Results: Over 3 years, 4142 pediatric clinic and 2638 pediatric neurology patients were reviewed. Elevated B12 levels were more frequent in the neurology clinic. Patients with elevated B12 levels (n = 338) had a mean age of 8.67 months and a mean B12 level of 894.7 pg/mL. Of 137 patients with follow-up B12 measurements, 40.1% normalized, while 17.5% remained > 1000 pg/mL. The most common diagnosis in patients with persistently high B12 levels was epilepsy, followed by prematurity, cerebral palsy, autism, intellectual disability, and language delay. Conclusions: Elevated vitamin B12 levels were associated with pediatric neurologic disorders, particularly epilepsy. Further research is needed to clarify the mechanisms and clinical implications of this finding.

Hypervitaminemia B12 has been associated or linked with a range of conditions, the majority of which are serious. Between March 26th, 2014 and June 30th, 2014, all patients aged ≥65 years, hospitalized in an acute geriatric unit in the university hospital center of Reims (France) were included in an observational study. 190 patients were included. 48 patients presented a hypervitaminemia B12 (25.3%). The gender ratio (M/F) of the population with elevated vitamin B12 levels was 0.5. 41 patients were aged ≥75 years (85.4%). The mean vitamin B12 level was 1,085 pg/mL (±428). 30 patients (62.5%) presented with moderate hypervitaminemia (<1,085 pg/mL), while 18 patients (37.5%) presented with elevated levels >1,085 pg/mL. Using the Chi2 or Fisher tests and the Student test, the factors with a significant link to hypervitaminemia B12 in univariate analysis were: acute renal failure (p=0.0002); liver diseases (p <0.0001) and solid neoplasia (p=0.0030). Using binary logistic regression for multivariate analysis, variables independently related to hypervitaminemia B12 were: acute renal failure: (odds ratio [OR]=6.3; 95%CI=2.7-8.1; p <0.0001); liver diseases (OR=5.4; 95%CI=3.1-6.9; p <0.0001); hematological disorders (OR=5.7; p=0.001); and age ≥75 years (OR=3.7; 95%CI=1.9-4.8; p=0.04). Moreover, there is an apparent correlation between rates of hypervitaminemia B12 and the number of etiologies identified (r=0.8; p=0.04). Our study confirm the significance of the link between hypervitaminemia B12 and hematological disorders in elderly patients, with a 5.7 fold higher risk.

HIGH PREVALENCE OF ELEVATED VITAMIN B12 LEVELS AT A TEACHING HOSPITAL

Purpose: In this study; we sought to assess whether elevated vitamin B12 levels during the course of diagnosis might be a predictor of acute leukemias.&#x0D; Materials and Method: The study was prepared by retrospectively evaluating the anamnesis and laboratory information of 95 patients diagnosed with acute leukemia (AML or ALL). Those who had any of the conditions clearly known to increase vitamin B12 levels by scanning their anamnesis and laboratory information were not included in the study.&#x0D; Results: In total, it was observed that serum vitamin B12 level at the time of diagnosis was above the normal reference range (&gt; 771ng/L) in 36% of the patients. In the survival analysis performed to evaluate the effect of high serum vitamin B12 levels on prognosis, no statistically significant difference was found.&#x0D; Conclusion: The data we obtained from this study; shows that high serum vitamin B12 levels may have predictive value for acute leukemia.

To find out which of the two predictors, Charlson co-morbidity index or vitamin B12, better estimates the risk of in-hospital mortality in seriously ill patients. Electronic hospital records of 1509 elderly patients aged 65 and older were retrospectively surveyed. Albumin, age and elevated vitamin B12 levels were significantly associated with increased in-hospital mortality. Charlson co-morbidity index was not significantly associated with death. The highest mortality (24.3%) was found in the group of patients who were concomitantly in the lowest albumin quartile and the highest vitamin B12 levels quartile. In this group, mortality increased significantly with age. By elasticity calculation, vitamin B12 capability to predict mortality was higher by ≈ 3 times than that of Charlson co-morbidity index. In view of the fact that vitamin B12 levels have been found to predict mortality, they should be measured in geriatric practice, in addition to albumin levels, as a practical and reliable tool for identifying high risk elderly hospitalized patients. Probably, a combination of two or more available and inexpensive routinely taken tests can give a better estimation of mortality than some complicated tools, like Charlson co-morbidity index.

BackgroundThis review was conducted to investigate the association between serum vitamin B12 levels as well as folic acid/vitamin B12 during pregnancy and the risk of gestational diabetes mellitus (GDM).MethodsA comprehensive search of electronic databases (Embase, PubMed, and Web of Science) was performed. The odds ratios (ORs) with 95% confidence intervals (CIs) of GDM risk were summarized using a random effects model. We also performed subgroup analyses to explore the source of heterogeneity.ResultsA total of 10 studies, including 10,595 pregnant women were assessed. Women with vitamin B12 deficiency were at higher risk for developing GDM when compared with those who were vitamin B12 sufficient (OR, 1.46; 95% CI 1.21–1.79; I2: 59.0%). Subgroup analysis indicated that this association might differ based on sample size and geographical distribution. Elevated vitamin B12 levels may decrease the risk of GDM by 23%. The role of excess folic acid and low vitamin B12 levels in the occurrence of GDM is also controversial.ConclusionIn summary, vitamin B12 deficiency is associated with increased risk of GDM, it is necessary to pay more attention to the balance of vitamin B12 and folic acid. However, more in-depth studies across multiple populations are needed to verify these results.

We aimed to investigate possible associations between systemic iron metabolism deficiency and Parkinson's disease, and also to research any possible correlations between stage of the disease and vitamin B12 and folic acid levels. 33 male and 27 female patients diagnosed with idiopathic Parkinson's disease and 22 male and 20 female age- and sex-matched controls were enrolled in the study. Having the diagnosis of secondary Parkinsonism or Parkinson plus syndromes, and for the females, not being in the menopausal stage were considered as exclusion criteria. Recordings of blood samples of both groups collected after 8 h fasts were assessed in terms of serum iron, ferritin levels and iron-binding capacity, vitamin B12 and folic acid levels. The Hoehn and Yahr scale was used to determine the stage of the disease. No statistically significant difference was found with respect to mean serum iron, median serum ferritin levels and median serum iron-binding capacity between the groups. A statistically significant but inverse correlation was found between symptoms' duration and serum iron and ferritin levels. There was no statistically significant difference between the groups with respect to vitamin B12 and folic acid levels. However, a statistically significant but inverse correlation was determined between the patients' vitamin B12 levels and the Hoehn and Yahr scores. As Parkinson's disease progresses, serum iron, ferritin and vitamin B12 levels may decrease. The lower levels of these parameters may be the cause of the progression or may be the result of it.

Utility and Patterns of Vitamin B12 and Folate Testing in Patients with Isolated Thrombocytopenia

There are conflicting studies reporting both an increase and a decrease in vitamin B12 (VB12) levels in non-alcoholic fatty liver disease (NAFLD). In this study, we aimed to dissect the effects of steatosis and fibrosis on VB12. This is a cross-sectional study including all patients with a vibration-controlled transient elastography (VCTE) performed at the Hospital Miguel Servet (Zaragoza, Spain) between 2019 and 2022 for a chronic liver disease and having a recent blood test for VB12 levels. Liver fibrosis was assessed by VCTE and hepatic steatosis by ultrasonography and/or through controlled attenuation parameter (CAP). 1195 patients (NAFLD n = 441, other chronic liver disease n = 754) were included. Median age was 57 years, 53% female. Patients with NAFLD had lower levels of VB12 compared to the rest of chronic liver diseases (289 vs. 313 pg/mL, p < 0.001). A significant negative correlation was observed between VB12 levels and hepatic steatosis measured by CAP (r = -0.13, p < 0.001). A significant positive correlation was observed between VB12 levels and liver stiffness in patients with NAFLD in both sexes (men r = 0.31, p < 0.001 and women r = 0.15, p = 0.016). A significant association between VB12 levels and liver fibrosis in cirrhosis stage was observed in patients with NAFLD (OR 1.06, 95% CI, 1.025-1.098, p = 0.001). VB12 levels were lower with greater hepatic steatosis. In NAFLD, VB12 levels were lower compared to other chronic liver diseases but their levels increased with higher liver stiffness and in cirrhosis stage.

Introduction: Our objective was to determine variation of hepatic enzymes Vitamin B12 and D3 levels in cirrhotic patients. Methods: This is a cross sectional study conducted in Abbasi Shaheed Hospital from November 2013 to May 2014. The sample size of the study is 250. 141 patients were male while 109 were female patients. Those who were diagnosed of Cirrhosis and previously infected with Hepatitis B and C virus were included.The analytical parameters determined were Vitamin B12, D3, ALT and GGT levels in blood. SPSS 19 was used. Results: Vitamin B12 levels were 1249.59±487.01pg/ml and 1422.28±627.75pg/ml in males and females respectively while Vitamin D3 levels were found to be 17.15±10.45 nmol/L in males and 14.80±14.24 nmol/L in females. Vitamin B12 levels were found to be positively correlated with the elevation of ALT and were negatively correlated with elevation of ALT, GGT and Alkaline Phosphatase. The ALT levels were 50.0±21.88 in males and 14.80±14.24 in females, Alkaline phosphatase to be 311.46±107.98 in males while female Alkaline phosphatase were 346.47±101.60. GGT levels to be 41.70±10.62 in males and 45.01±13.74 in females. Conclusion: The majority of subjects with CHC are vitamin D deficient ( < 50 nmol/L)27 with 25% having severe deficiency ( < 25 nmol/L) [28]. In those with chronic liver disease the prevalence of vitamin D insufficiency ( < 75 nmol/L) is almost universal, with vitamin D deficiency ( < 50 nmol/L) present in around two-thirds of subjects. Various studies suggest that vitamin D effects may play a significant role in the pathogenesis of chronic liver diseases.Even in the absence of cirrhosis, vitamin D deficiency is present in the majority of subjects. In those with cirrhosis, the prevalence of severe vitamin D deficiency ( < 25 nmol/L) increases with increasing severity of synthetic liver dysfunction.Another study also showed that vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C.Our findings suggest that cirrhotic patients admitted for complications presented with elevated plasma levels of vitamin B12 which were 1249.59±487.01pg/ ml in males and 1422.28±627.75pg/ml in females. The results also demonstrate a positive association between vitamin B12 and the hepatic enzymes where ALT is 50.0±21.88 pg/ml and 50.96±11.20 pg/ml, and GGT is 41.70±10.62 and 45.01±13.74 pg/ml in males and females respectively.Figure 1