Blood Vitamin B12 Research Articles

Variation of Hepatic Enzymes With Vitamin B12 and Vitamin D3 Levels in Cirrhotic Patients

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

A dose-response meta-analysis reveals an association between vitamin B12 and colorectal cancer risk.

The current meta-analysis evaluated the association between vitamin B12 intake and blood vitamin B12 level and colorectal cancer (CRC) risk. The PubMed and EMBASE databases were searched. A dose-response analysis was performed with generalized least squares regression, with the relative risk (RR) and 95 % CI as effect values. The meta-analysis included seventeen studies. A total of 10 601 patients. The non-linear dose-response relationship between total vitamin B12 intake and CRC risk was insignificant (P=0·690), but the relationship between dietary vitamin B12 intake and CRC risk was significant (P<0·001). Every 4·5 μg/d increment in total and dietary vitamin B12 intake was inversely associated with CRC risk (total intake: RR=0·963; 95 % CI 0·928, 0·999; dietary intake: RR=0·914; 95 % CI 0·856, 0·977). The inverse association between vitamin B12 intake and CRC risk was also significant when vitamin B12 intake was over a dosage threshold, enhancing the non-linear relationship. The non-linear dose-response relationship between blood vitamin B12 level and CRC risk was insignificant (P=0·219). There was an insignificant association between every 150 pmol/l increment in blood vitamin B12 level and CRC risk (RR=1·023; 95 % CI 0·881, 1·187). Our meta-analysis indicates that evidence supports the use of vitamin B12 for cancer prevention, especially among populations with high-dose vitamin B12 intake, and that the association between CRC risk and total vitamin B12 intake is stronger than between CRC risk and dietary vitamin B12 intake only.

Blood examination is necessary for oral mucosal disease patients.

According to the World Health Organization (WHO), anemia or hemoglobin deficiency is defined as having a hemoglobin concentration 12.4 mM). Serum gastric parietal cell autoantibody (GPCA) positivity may induce destruction of gastric parietal cells and subsequently result in failure of production of intrinsic factor and absorption of vitamin B12 from the terminal ileum, finally leading to vitamin B12 deficiency. Because anemia and hematinic deficiencies may cause or aggravate oral mucosal diseases such as atrophic glossitis (AG), burning mouth syndrome (BMS), oral lichen planus (OLP), recurrent aphthous ulcerations (RAU), or oral submucous fibrosis (OSF), in our oral mucosal disease clinic, complete blood count, serum iron, vitamin B12, folic acid and homocysteine levels, and serum GPCA titers are usually examined to check whether patients with these 5 diseases have microcytic, normocytic or macrocytic

Association of maternal homocysteine and vitamins status with the risk of neural tube defects in Tunisia: A case-control study.

This study was conducted to determine whether low folate and vitamin B12 levels, as well as high homocysteine levels in pregnant women are associated with neural tube defects (NTDs) in Tunisia. A total of 75 NTDs pregnancies and 75 matched controls were included in the study. Their vitamin B12, folate, and red blood cell folate concentrations were measured using a radio-immunoassay kit and total homocysteine concentrations were determined using a fluorescent polarization immunoassay. Vitamin B12 and folate concentrations were lower in NTD-affected pregnant women than in controls (respectively, p = 0.009 and p < 0.001). Total homocysteine concentration was significantly higher in the NTDs group than in controls (p = 0.008). In the case group, the folate levels were positively related with vitamin B12 levels (r = 0.54; p < 0.001) and negatively correlated with total homocysteine levels (r = -0.19; p = 0.04). Besides, red blood cell folate levels were positively correlated with folate levels (r = 0.24; p = 0.02) and negatively correlated with total homocysteine levels (r = -0.37; p = 0.001). Lower concentrations of folate and vitamin B12 are related to the increased risk of NTDs. Both folate and vitamin B12 intake insufficiency could contribute to the increased risk of NTDs. A dietary supplement, combining folate and vitamin B12, might be an effective measure to decrease the NTDs incidence in Tunisia.

Do all the patients with vitamin B12 deficiency have pernicious anemia?

Vitamin B12 deficiency may result in pernicious anemia (PA). This study evaluated whether all the patients with vitamin B12 deficiency had PA. The blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine concentrations and mean corpuscular volume (MCV) in 90 vitamin B12-deficient patients were measured and compared with the corresponding data in 180 age- and sex-matched healthy control subjects. PA was defined by World Health Organization (WHO) as having an Hb concentration <13 g/dl for men and <12 g/dl for women, an MCV ≧ 100 fl, a serum vitamin B12 level <200 pg/ml, and serum gastric parietal cell antibody (GPCA) positivity. We found that 35 (38.9%) and 20 (22.2%) patients with vitamin B12 deficiency had deficiencies of Hb (men <13 g/dl, women <12 g/dl) and iron (<60 μg/dl), respectively. Moreover, 65 (72.2%) and 37 (41.1%) patients with vitamin B12 deficiency had abnormally high blood homocysteine level (>12.7 μM) and high MCV (≧100 fl), respectively. In addition, 43 (47.8%) vitamin B12-deficient patients with had GPCA positivity. Patients with vitamin B12 deficiency had a significantly higher frequency of Hb or iron deficiency, of abnormally elevated blood homocysteine level or high MCV, and of GPCA positivity than healthy control subjects (all P-values < 0.001). However, only 17 (18.9%) of 90 vitamin B12-deficient patients were diagnosed as having PA by the WHO definition. Only 18.9% of patients with vitamin B12 deficiency are discovered to have PA by the WHO definition.

Hematinic deficiencies and pernicious anemia in oral mucosal disease patients withmacrocytosis.

Macrocytosis is defined as having the mean corpuscular volume (MCV) ≥ 100 fL. This study assessed hematinic deficiencies and pernicious anemia (PA) in oral mucosal disease patients with macrocytosis. The blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine concentrations and MCV in 60 oral mucosal disease patients with macrocytosis were measured and compared with the corresponding data in 120 age- and sex-matched healthy control participants. PA was defined by the World Health Organization (WHO) as having an Hb concentration < 13 g/dL for men and < 12 g/dL for women, an MCV ≥ 100 fL, a serum vitamin B12 level < 200 pg/mL, and serum gastric parietal cell antibody (GPCA) positivity. We found that 30 (50.0%), 7 (11.7%), 24 (40.0%), and three (5.0%) oral mucosal disease patients with macrocytosis had deficiencies of Hb (men < 13 g/dL, women < 12 g/dL), iron (< 60 μg/dL), vitamin B12 (< 200 pg/mL), and folic acid (< 4 mg/mL), respectively. Moreover, 38 (63.3%) and 16 (26.7%) macrocytosis patients had abnormally high blood homocysteine level (> 12.3 μM) and serum GPCA positivity, respectively. Macrocytosis patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency, of abnormally elevated blood homocysteine level, and of GPCA positivity than healthy control participants (p < 0.001). However, only 16.7% of 60 macrocytosis patients were diagnosed as having PA by the WHO definition. Only 16.7% of oral mucosal disease patients with macrocytosis are discovered to have PA by the WHO definition.

Quantitative assessment of maternal biomarkers related to one-carbon metabolism and neural tube defects

Periconceptional supplementation with folic acid reduces the occurrence of neural tube defects (NTDs). The association between maternal abnormalities in homocysteine metabolism (e.g., hyperhomocysteinaemia, folate deficiency and low vitamin B12) and the risk of NTDs-affected pregnancies has been widely evaluated in recent years, although the results are conflicting. To investigate this inconsistency, we performed a meta-analysis of 32 studies, involving 1,890 NTD-affected mothers and 3,995 control mothers, to develop an understanding of the relationship between maternal biomarkers related to one-carbon metabolism and NTD. A random-effects model was used to calculate the ratio of means (RoM) between the cases and controls, along with the 95% confidence intervals (CIs). A significant increase in homocysteine levels was observed in NTD-affected mothers compared with controls (RoM: 1.16, 95% CI: 1.09–1.23, P = 1.8 × 10−6). The pooled analysis also revealed that NTD-affected mothers had significantly lower levels of folate (RoM: 0.93, 95% CI: 0.88–0.97, P = 0.002), vitamin B12 (RoM: 0.91, 95% CI: 0.87–0.95, P = 3.6 × 10−5) and red blood cell folate (RoM: 0.92, 95% CI: 0.86–0.98, P = 0.01). Therefore, altered plasma levels of biomarkers related to one-carbon metabolism are associated with NTD-affected pregnancies.

Associations between Alzheimer's disease and blood homocysteine, vitamin B12, and folate: a case-control study.

There is a growing focus on nutritional therapy for Alzheimer's disease (AD), and controversy exists regarding the association between AD and homocysteine (Hcy), vitamin B12, and folate levels. The present study evaluated the association between AD and the combined levels of Hcy, vitamin B12, and folate. This case-control study consisted of 115 patients with AD and 115 matched controls. Serum folate and vitamin B12 were measured using an automated immunoassay analyzer. Plasma Hcy was measured using high-performance liquid chromatography. The association between AD and Hcy, vitamin B12, and folate was analyzed using binary logistic regression, adjusted for age and sex. With the combination of normal blood Hcy, vitamin B12, and folate levels as the reference category, low vitamin B12 in subjects with normal Hcy and folate was associated with AD (adjusted odds ratio [OR], 4.6; 95% confidence interval [CI]: 1.6-13.2). The combination of low vitamin B12 and folate in subjects with normal Hcy was associated with AD (adjusted OR, 4.3; 95% CI: 1.3-14.6). The combination of high Hcy and low folate levels in patients with normal vitamin B12 was associated with AD (adjusted OR, 17.0; 95% CI: 5.4- 53.4). The combination of high Hcy, low vitamin B12, and any folate level was associated with AD (adjusted OR, 30.5; 95% CI: 9.7-95.9). Vitamin B12 was directly associated with AD. The combination of high Hcy, low vitamin B12, and any folate level represented the poorest association with AD.

Vitamin B12 – time to get active

Vitamin B12 deficiency is an important cause of neurological and haematological disease. The clinical signs are non-specific and haematological changes may be masked by concurrent iron deficiency. Serum total vitamin B12 (TB12) measurement is the recommended first-line test but the result can be misleading because of method biases approaching 30% and the presence of different circulating forms of this vitamin. Approximately 80% of vitamin B12 in blood is bound in inert complexes with haptocorrin (Hapto-TC). The remainder is bound with transcobalamin (Holo-TC or ‘active B12’) which is the active fraction that enters cells for metabolic reactions involving homocysteine and methylmalonic acid. An automated HoloTC assay has been developed and recently endorsed as one of the second-line tests when the TB12 result is low or equivocal. The Holo-TC assay may have better sensitivity and specificity. Falsely low serum TB12 results due to low Hapto-TC concentrations can be seen in pregnancy1 or in individuals with heterozygous haptocorrin deficiency.2 Conversely, some haematological disorders result in increased production of haptocorrin which can lead to falsely high serum TB12. In these settings the measurement of Holo-TC may prove a more effective test for diagnosis of B12 deficiency.

Variation of hepatic enzymes with Vitamin B12 and D3 levels in cirrhotic patients

OBJECTIVE: To determine variation of hepatic enzymes Vitamin B12 and D3 levels in cirrhotic patients. DESIGN: Cross sectional study. SETTING: Cirrhotic patients in Abbasi Shaheed Hospital. PARTICIPANTS: 250 patients in Abbasi Shaheed Hospital with diagnosis of cirrhosis including 141 males and 109 females. VARIABLE PARAMETERS: They include mean ALT, GGT, Alkaline phosphatase levels along with Vitamin B12 and D3 levels in blood. 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: Cirrhotic patients suffering from severe hepatocellular damage have their elevated levels of Vitamin B12 and depressed Vitamin D3 levels in plasma accompanied by a positive association with elevated ALT and GGT plasma levels

Significant association of deficiencies of hemoglobin, iron, folic acid, and vitamin B12 and high homocysteine level with oral lichen planus

A portion of patients with oral lichen planus (OLP) may have nutritional deficiency. This study evaluated whether there was an intimate association of the deficiencies of hemoglobin (Hb), iron, vitamin B12, and folic acid and high blood homocysteine level with OLP. The blood Hb, iron, vitamin B12, folic acid, and homocysteine concentrations in 352 OLP patients were measured and compared with the corresponding levels in 352 age- and sex-matched healthy control participants. We found that 77 (21.9%) OLP patients, 48 (13.6%) OLP patients, 25 (7.1%) OLP patients, and one (0.3%) OLP patient had deficiencies of Hb (men < 13g/dL, women < 12g/dL), iron (< 60μg/dL), vitamin B12 (< 200pg/mL), and folic acid (< 4ng/mL), respectively. Moreover, 52 (14.8%) OLP patients had abnormally high blood homocysteine level. OLP patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency and of abnormally elevated blood homocysteine level than healthy control participants (all p<0.001). Upon further dividing OLP patients into those with major erosive OLP (MjEOLP; n=67), minor erosive OLP (n=202), and nonerosive OLP (NEOLP; n=83), we found that MjEOLP patients had a significantly higher mean homocysteine level than NEOLP patients (p=0.035). We conclude that there is a significant association of deficiencies of Hb, iron, folic acid, and vitamin B12 and abnormally high blood homocysteine level with OLP. There may be a close relation of high blood homocysteine level to severity of OLP.

Nutritional and Micronutrient Status of Elderly People Living in a Rural Community of Bangladesh

Background: To assess the nutrition and micronutrient status of elderly population in the rural area of Bangladesh. Method: Healthy 44 elderly (≥ 60 years) and 88 middle aged (40–59 years) men and women were studied during April-September 2010. Their anthropometric status, micronutrient status and biochemical markers were assessed. Result: Mean body mass index (BMI), hemoglobin, alanine transaminase (ALT), albumin, vitamin B12, and fasting blood sugar (FBS) were significantly lower and serum creatinine, vitamin D and folate were significantly higher among elderly compared to that of middle aged population. However, uric acid (UA), calcium, zinc, and retinol were identical in both the groups. Individual being elderly, impacted on decreased level of hemoglobin (0.67 gm/dl), vitamin B12 (38.76 pmol/L), albumin (0.12 gm/dL), zinc (0.03 mg/L) and FBS (0.88 μmol/L) after adjusting for covariates. Conclusion: Elderly had compromised nutritional status with lower levels of hemoglobin, FBS, vitamin and micronutrient.

Serum Vitamin B12 Levels in Two Subpopulations of Healthy Workers in Israel: Differences by Land of Birth

Background: Clinical and subclinical vitamin B12 deficiency rates are lower in western populations compared to developing populations and cut-off points for defining deficiency are inconsistent. Objectives: The present study was designed to examine variability in vitamin B12 blood levels in a heterogeneous population. Methods: The present report is a cross-sectional analysis of serum vitamin B12 levels recorded for 1969 apparently healthy hospital workers employed at Tel Aviv Medical Centre, Tel Aviv, Israel, who underwent blood vitamin B12 tests evaluation as part of the routine occupational health evaluation. Data were extracted from the electronic employee medical record. Results: Almost 73% of the study population was born in Israel, and 73.6% of the population was female. Serum vitamin B12 levels were significantly lower in Israeli born women than in women born outside of Israel: 294±119.9 vs. 320±121.7pmol/L. Land of birth and sex were significant, independent predictors of serum vitamin B12 levels even after controlling for age and year in which the serum vitamin B12 was measured. In a logistic regression model of serum vitamin B12 < 350 pmol/L, land of birth emerged as the only significant, independent predictor, such that being born in Israel increased odds of serum vitamin B12 < 350 pmol/L by a relative 44% (95% CI 17-78%, p=0.001). Discussion: Wide serum vitamin B12 level variability in heterogeneous populations suggests that cut-offs for deficiency may need to be subgroup-specific in order to be clinically meaningful. It is not clear whether presently used clinical cut-offs are associated with increased morbidity in a given population.

Elevated homocysteine levels in human immunodeficiency virus-infected patients under antiretroviral therapy: A meta-analysis.

To evaluate the association between the levels of homocysteine (Hcy), folate, vitamin B12 in human immunodeficiency virus (HIV)-infected patients who were treated with antiretroviral therapy (ART) or not treated with ART. The PubMed and Scielo databases were searched. Eligible studies regarding plasma Hcy level in HIV-infected patients were firstly identified. After careful analysis by two independent researches, the identified articles were included in the review according to two outcomes (1) Hcy, folate and vitamin B12 blood concentration in HIV-infected subjects vs health controls and; (2) Hcy blood concentration in HIV-infected subjects under ART vs not treated with ART. RevMan (version 5.2) was employed for data synthesis. A total of 12 studies were included in outcome 1 (1649 participants, 932 cases and 717 controls). Outcome 1 meta-analysis demonstrated higher plasma Hcy (2.05 µmol/L; 95%CI: 0.10 to 4.00, P < 0.01) and decreased plasma folate concentrations (-2.74 ng/mL; 95%CI: -5.18 to -0.29, P < 0.01) in HIV-infected patients compared to healthy controls. No changes in vitamin B12 plasma concentration were observed between groups. All studies included in the outcome 2 meta-analysis (1167 participants; 404 HIV-infected exposed to ART and 757 HIV-infected non-ART patients) demonstrated higher mean Hcy concentration in subjects HIV-infected under ART compared to non-ART HIV subjects (4.13 µmol/L; 95%CI: 1.34 to 6.92, P < 0.01). This meta-analysis demonstrated that the levels of Hcy and folate, but not vitamin B12, were associated with HIV infection. In addition, Hcy levels were higher in HIV-infected patients who were under ART compared to HIV-infected patients who were not exposed to ART. Our results suggest that hyperhomocysteinemia should be included among the several important metabolic disturbances that are associated with ART in patients with HIV infection.

Changes of lipidemia after one month of creatine supplementation

It was proved in two independent experimental studies with the same group of 11 young sportsmen that creatine (CR) given as food supplement interfered with the metabolism of one- and two-carbon units. CR, given in one dose of 5 g daily during one month, induced reciprocal changes of muscle mass and body fat. These changes were characteristic of each of the four proband groups, into which the probands were divided on basis of the increased or decreased level of CR in urine, and the increased or decreased levels of folates and vitamin B12 in blood. The comparison of results of short- and long-term CR supplementations showed that individual deviations found within the rank of each group are characteristic for each person under study. The changes of the level of thiodiglycolic acid in urine proved to be good markers for deviations from homeostasis.

Vitamin B12, folate and iron levels in primary nocturnal enuresis.

Objective:Folate, vitamin B12 and iron are important vitamin and minerals which play role in the development of nervous system. The aim of this study was looking at the presence of folate, vitamin B12 and iron deficiency among patients with Primary nocturnal enuresis (PNE) and possible relation between the delay of central nervous system (CNS) development, PNE and folate, vitamin B12 and iron states.Methods: Consecutively applied forty patients with PNE (23 girls and 17 boys) and otherwise normal thirty control subjects (17 girls and 13 boys) were included in the study. Average ages (in range) of PNE and the control group were 9.2(6-12) years and 9.3 (6-12) years accordingly. Age, height, weight, complete blood count, blood vitamin B12, folate, ferritin and iron values of both groups were recorded and compared to each other.Results:Average vitamin B12 and folate levels of patients with PNE were significantly and statistically lower compared to those of the control group. Average blood iron of patients with PNE was significantly higher than that of the control group and also average ferritin level of the PNE group was detected to be higher than the control group but this relation was statistically insignificant.Conclusion: Primary nocturnal enuresis is related to the delay in CNS maturation so it was thought that low vitamin B12 and folate which were found in patients with PNE may have role in the delay of CNS maturation. Additionally, further studies are needed to investigate the role of vitamin B12 and folate either alone or as combination in treatment of patients with PNE who have low vitamin B12and folate level.

Prevalence of anemia and related deficiencies 10 years after gastric bypass--a retrospective study.

Bariatric surgery has gained wide acceptance as treatment for severe obesity and is associated with decreased overall mortality. The aims of this study were to evaluate the prevalence of anemia long term after Roux-en-Y gastric bypass (RYGB) and to search for factors predicting anemia. All 745 patients who underwent RYGB between 1993 and 2003 at either Örebro or Uppsala University Hospital and who were living in Sweden were invited to participate by providing a fasting blood sample and completing a questionnaire about their health status. Full blood count, serum iron, transferrin, vitamin B12, and folic acid were determined. Follow-up was completed in 431 patients (58 %) with mean age 51.3 ± 10 years. Of all patients, 27 % had anemia postoperatively and related deficiencies; iron, folic acid, and vitamin B12 were seen in 20, 12, and 2 %, respectively. There was no correlation between anemia and sex, follow-up time, 25-OH vitamin D level, and preoperative or postoperative BMI. An inverse correlation was found between anemia and regular medical checkups concerning gastric bypass surgery. Twenty-seven percent of patients had anemia more than 10 years after RYGB. Anemia does not seem to progress with time and was less common in patients with regular medical checkups. Thus, improved long-term follow-up is needed.

Potential over request in anemia laboratory tests in primary care in Spain

ObjectivesThe aim was to study the inter-practice variability in anemia laboratory tests requested by general practitioners in Spain, to evaluate for a potential requesting inappropriateness.MethodsLaboratories from diverse Spanish regions filled out the number of cell blood count, ferritin, folate, iron, transferrin, and vitamin B12 requested by general practitioners during 2012. The number of test requests per 1000 inhabitants and ratios of related tests requests were calculated. The results obtained in hospitals from different areas (urban, rural, or urban–rural), type of management (public or private), and geographic regions were compared.ResultsThere was a high variability in the number of test requests and ratios of related tests. Cell blood count was over requested in rural areas and in hospitals with private management. Andalucía was the community with the lowest number of iron requests and the lowest folate/vitamin B12 indicator value.ConclusionsIron and transferrin seemed over requested in some areas; as were folate and ferritin when compared to vitamin B12 and cell blood count, respectively. The differences observed between areas indicate that other factors besides clinical reasons could be behind that variability and emphasize the need to accomplish interventions to improve the appropriate use of anemia laboratory tests.

Folic acid and vitamin-B12 in idiopathic sensorineural hearing loss in children

Abstract The aim of the study was to evaluate the role of vitamin-B12 and folate blood concentrations in children suffering from moderate, severe, and severe-to-profound sensorineural hearing loss (SNHL). This study was conducted on 95 children: 30 children with severe-to-profound SNHL who were scheduled for cochlear implantation, 25 children who are hearing aid users for moderate and severe SNHL, and another 40 healthy volunteers considered as the control group. Full audiological examination was performed to all children, as well as computed tomographic scan and MRI to temporal bone were performed for the SNHL groups. Median vitamin-B12 and folic acid levels were significantly higher in the control group 3 than in the SNHL groups 1 and 2 patients (P < 0.001). There was no significant correlation between vitamin-B12 and folic acid levels and the other parameters. There was no significant difference between groups 1 and 2 with respect to median vitamin-B12 and folic acid level. Study demonstrated that the serum levels of folate and vitamin-B12 are decreased in patients with SNHL. Measurement of folic acid and vitamin-B12 in patients suffering SNHL might be useful. These data may give us some clues about how hearing loss is developed in these patients.

Folate Testing in Hospital Inpatients

IntroductionSince Canada began fortifying grain products with folic acid in 1998, the rate of folate deficiency in outpatients has decreased substantially. Limited data exist on the prevalence of folate deficiency in Canadian hospital inpatients. MethodsThe electronic patient record at a large urban academic institution was reviewed for all red blood cell folate and vitamin B12 level tests performed on inpatients between January 1 and December 31, 2010. Chart reviews were performed on patients found to have folate deficiency to determine the indication for folate testing and the etiology of deficiency. ResultsThere were 2563 red blood cell folate and 3154 vitamin B12 level tests performed in 2010. Of these, only 4 (0.16%) red blood cell folate levels were in the deficient range (<254 nmol/L), compared with 98 (3.1%) and 426 (13.5%) vitamin B12 levels that were in the deficient (<138 pmol/L) and intermediate (138-221 pmol/L) range, respectively. Of the 4 patients with folate deficiency, the etiology appeared to be alcohol abuse in one, a malabsorption syndrome in the second, decreased oral intake due to schizophrenia in the third, with the final low folate level appearing to be spurious. At a cost of $12.54 per test, $32,140 could be saved each year at this institution if red blood cell folate testing on inpatients was restricted. ConclusionFolate deficiency in inpatients is nearly nonexistent, while an appreciable number of patients have low/intermediate vitamin B12 levels. Significant savings could be achieved by eliminating folate testing on inpatients.