Vitamin E sufficiency in children with cholestasis: A comparison between erythrocyte peroxide hemolysis and serum α-tocopherol

Abstract

Vitamin E sufficiency was assessed in 19 children with chronic cholestasis by determining both erythrocyte peroxide hemolysis (EPH) and serum α-tocopherol (α-T) levels. Eight had normal α-T (1.19 ± 0.67 mg/dl; normal > 0.5). The mean EPH in this group was 13.1 ± 14.3% (normal < 20%). The remaining 11 patients had low α-T levels (0.25 ± 0.15 mg/dl) and elevated EPH (83.9 ± 17.1%). Children found to be vitamin E deficient received either oral α-T (50–100 IU/kg per day) or parenteral α-tocopherol acetate in sesame oil every 2–4 wk (200–300 mg). This permitted serial monitoring of EPH and α-T. We found that normalization of the EPH was uniformly accompanied by normalization of the α-T level. However, normal α-T levels occurred with elevated EPH (between 20% and 80%) on 11 occasions. EPH > 80% correctly identified vitamin E deficiency in all cases. Hence, EPH is a satisfactory screening test of vitamin E sufficiently. When the EPH is < 20%, the patient is vitamin E sufficient. Conversely, when the EPH is > 80%, the patient is vitamin E deficient. Serum α-T measurements are needed to determine vitamin E sufficiency when the EPH is > 20% and < 80%.