Low Serum Vitamin B12 Levels Research Articles

RELATIONSHIP BETWEEN VITAMIN B12 LEVELS AND ADVERSE LIPID PROFILES IN APPARENTLY HEALTHY INDIVIDUALS VISITING WELLNESS ASSESSMENT CENTER: A PROSPECTIVE STUDY

Objective: For metabolic disorders, an abnormal lipid profile stands alone as a risk factor. Since most research has been done on unhealthy populations, a relationship in vitamin B12 deficiency and lipid profile is unclear.
 Methods: We conducted a cross-sectional research with 201 apparently healthy vitamin B12 deficient people, aged 25 to 60, in order to evaluate a relationship in serum vitamin B12 levels and lipid profiles.
 Results: Sociodemographic, anthropometric, and biochemical data has been collected. Serum vitamin B12 deficiency has defined as serum B12 level of<159 pmol/l.25% of the subjects had raised cholesterol, 70% had raised LDL, 35% had raised triglycerides, and 71% had low HDL. We observed that only MCV was negatively associated with vitamin B12 levels (P<0.0001). A remaining other variables, including lipid profile were not associated with vitamin B12 levels. We also found that presence of comorbidities was not significantly associated with vitamin B12 levels (P=NS).
 Conclusion: Therefore, in apparently healthy individuals, low serum vitamin B12 levels are not linked with abnormal lipid profiles.

Nitrous oxide abuse in a 21-year-old female: a case report and review of literature.

The abuse of nitrous oxide (N2O) poses a substantial public health challenge. In many countries, including China, regulations governing the utilization and accessibility to N2O remain ambiguous, particularly within the food industry. Here, we report a case of a 21-year-old female who presented with symptoms of subacute combined degeneration (SCD) of the spinal cord due to N2O abuse. The patient exhibited bilateral lower limb numbness and weakness, low serum vitamin B12 levels with elevated homocysteine levels, and lumbar spine magnetic resonance imaging (MRI) revealed abnormal signals of the spinal cord. Following cessation of N2O and comprehensive therapy including methylcobalamin and nerve growth factor, the symptoms significantly improved. A follow-up examination 3 months later showed good progress in gait stability. At a 5-year follow-up, the patient's previous clinical symptoms had completely disappeared, and her quality of life had returned to normal. This case underscores the urgency of raising awareness and prevention of N2O abuse, emphasizing the importance of timely diagnosis and comprehensive treatment for patient recovery. Clear formulation and enforcement of relevant regulatory measures are equally crucial in reducing instances of abuse.

Prevalence and Predictors of Vitamin B12 Deficiency in Children with Severe Acute Malnutrition, and its Association with Development.

To determine the proportion of children with severe acute malnutrition (SAM) having vitamin B12 deficiency, its clinical predictors, and its association with development. In this cross-sectional study, 100 children between 1 mo to 59 mo [mean (SD) age 17 (12.75) mo; 55 males], with diagnosis of SAM as per WHO criteria, were included. Serum vitamin B12, serum folate, and serum ferritin levels were measured by chemiluminescence immunometric assay method, while serum Homocysteine (Hcy) level was measured by enzymatic cycling method. Development assessment was done by Denver Development Screening Tool (DDST-II). The mean (SD) serum vitamin B12 (cobalamin) levels were 296.52 (246.95) pg/mL; 45% children were vitamin B12 deficient (<203 pg/mL). Hyperhomocysteinemia (>14 µmol/L) was present in 39 (39%), and among these 69% (27/39) children had concomitant low serum vitamin B12 levels. Severe anemia and hypoproteinemia were significantly and independently associated with vitamin B12 deficiency [aOR (95% CI) 3.22 (1.13, 10) and 10 (1.66, 58.82), respectively]. Out of 45 children who were vitamin B12 deficient, 93%, 87%, 62% and 80% had gross motor, fine-motor, language and adaptive-cognitive delay, respectively. Vitamin B12 level was significantly associated (P <0.001) with developmental delay. There is a high prevalence of vitamin B12 deficiency in children with SAM, which is also associated with development delay across all domains (except language) in these children.

Nutritional vitamin B12 deficiency-associated Infantile epileptic spasms syndrome: Clinico-neurophysiological presentation, response to treatment, and neurodevelopmental outcome

IntroductionNutritional vitamin B12 deficiency has been shown to cause Infantile epileptic spasms syndrome (IESS) in infants in anecdotal studies. MethodsIn this retrospective cohort study, we intended to study the clinical presentation, neurophysiological, laboratory abnormalities, treatment, and neurodevelopmental outcome at 6-months in infants presenting with IESS secondary to nutritional vitamin B12 deficiency (NVBD) and to compare these variables from the rest of the infants with IESS without vitamin B12 deficiency. We included only spasm-free cases or those who showed at least a 50% reduction in spasm frequency on D7 after starting oral/parenteral vitamin B12. We used well-validated measurement tools like the Developmental Assessment Scale for Indian Infants (DASII), Child Feeding Index (CFI), Burden of amplitudes and epileptiform discharges (BASED) score, countable Hypsarrhythmia paroxysm index (cHPI), durational Hypsarrhythmia paroxysm index (dHPI), and Early childhood epilepsy severity scale (E-CHESS) score for documenting these variables. ResultsData from 162 infants with IESS (21 caused by NVBD) were included in our study. The NVBD group had more patients residing in the rural region, with lower socioeconomic status, vegetarian mothers and poor complementary feeding index (p<0.001 for all). The NVBD group also had less number of patients requiring antiseizure medications (ASMs) and hormonal therapy(p<0.001), remained seizure free at six months (p=0.008), lower number of clusters per day (p=0.02) and the number of spasms per clusters at presentation (p=0.03), lower BASED score (p=0.03) and cHPI, dHPI at presentation (p<0.001). All of them remained spasm-free, with normal electroencephalogram at 6-months. Development quotient at baseline, at 6-months, and improvement in development quotient between these two-time points were more in the vitamin B12 deficiency group (p<0.001). All of them had clinical features of pre-ITS (infantile tremor syndrome) or ITS and it was found to be the only independent predictor of NVBD in infants with IESS. Mothers of all these infants had low serum vitamin B12 levels (<200 pg/ml). ConclusionsNutritional vitamin B12 deficiency may cause IESS in infants. Hence, vitamin B12 deficiency needs to be ruled out in patients with IESS without any definite etiology.

Associations of Dietary Patterns and Vitamin D Levels with Iron Status in Pregnant Women: A Cross-Sectional Study in Taiwan.

Vitamin D is involved in the pathophysiology of anemia. This cross-sectional study was conducted using the Nationwide Nutrition and Health Survey in Pregnant Women in Taiwan database. We investigated associations among dietary patterns (DPs), vitamin D, and iron-related biomarkers in pregnant women. The principal component analysis revealed four DPs. Linear and logistic regression analyses were performed to investigate the association of DPs with anemia-related biomarkers. Plant-based, carnivore, and dairy and nondairy alternatives DPs were positively associated with serum vitamin D levels. After adjusting covariates, the pregnant women consuming plant-based DPs at the mid-tertile (T2) were associated with reduced risks of low serum folate and vitamin D levels, and those consuming carnivore DPs at higher tertiles (T2 and/or T3) were correlated with an increased risk of low serum iron levels but decreased risks of low serum transferrin saturation, vitamin B12, and vitamin D levels. The pregnant women consuming dairy and nondairy alternatives DPs at the highest tertile (T3) were associated with reduced risks of low serum folate and vitamin B12 levels. However, the processed food DP was not correlated with anemia-related biomarkers. Thus, plant-based, carnivore, and dairy and nondairy alternatives DPs were associated with the risk of low-serum-anemia-related variables.

Is there a relationship between metformin-related gastrointestinal symptoms and vitamin B12 deficiency in patients with type 2 diabetes mellitus?

Metformin (MTF) associated gastrointestinal symptoms are fairly common side effects that adversely affect patients' treatment adherence. However, the variability of gastrointestinal symptoms in MTF-using patients has not been fully explained. In our study, we aimed to investigate the relationship between vitamin B12 deficiency with MTF-related gastrointestinal symptoms. Patients with type 2 diabetes mellitus (T2DM) using MTF were included in the study sequentially. Demographic characteristics of the patients, duration of diabetes, MTF dose and duration used, and gastrointestinal symptoms were recorded. Afterward, a hemogram, HgbA1c, and vitamin B12 measurements were performed. Patients with and without vitamin B12 deficiency were divided into two groups. The two groups were compared with statistical methods. Twenty-five percent of patients had low serum vitamin B12 levels. Patients with vitamin B12 deficiency had a longer diabetes duration, and a longer MTF usage duration (p&lt;0.001, p&lt;0.001) than the patients without vitamin B12 deficiency. There was no correlation between B12 deficiency and MTF dosage (p=0.590). Gastrointestinal symptoms were seen more frequently in the B12 deficiency group (p=0.025). Bloating and constipation, nausea, abdominal pain, and vomiting were seen commonly in the B12 deficiency group (p=0.002, p&lt;0.001, p=0.014, p=0.004, respectively). Three or more symptoms were frequently seen in B12-deficient patients (p&lt;0.001). Patients with both a MTF usage duration of 10 years or higher and vitamin B12 deficiency are found to be 434% more likely to have active gastrointestinal symptoms than all other patient groups (OR:5.343, 95%CI (2.173-13.140), p&lt;0.001). Study results have shown that gastrointestinal symptoms seen in patients with T2DM taking MTF may be associated with vitamin B12 deficiency. MTF-related gut microbiome changes may play a role in this relationship. In particular, we recommend that patients who have been using MTF for ≥10 years and have gastrointestinal complaints should be followed more closely for vitamin B12 deficiency.

Acral Acanthosis Nigricans with Concurrent Vitamin B12 Deficiency in an Indian Patient: An Atypical Presentation

Acanthosis Nigricans (AN) is characterised by velvety, papillomatous, brownish-black, hyperkeratotic plaques, typically on the intertriginous areas and neck. It is more commonly seen in the African American descent, rarely occurs in the Indian population. The present case includes 28-year-old male, who presented to the Outpatient Department with asymptomatic hyperpigmention over skin of both feet and knuckles of both hands since three months. The distribution pattern over the knuckles was suggestive of vitamin B12 deficiency however the atypical distribution over the feet leads to suspicion of a differential diagnosis of lichen planopigmentosus, vitamin B12 deficiency and acral AN. Dermoscopy was done to aid in the diagnosis and revealed linear crista cutis and sulcus cutis which are features suggestive of AN. On investigation, serum vitamin B12 levels were below 100 µg/mL and histologic sections showed hyperkeratosis with papillomatosis and mild acanthosis. The patient was treated solely with 1500 mcg mecobalamine daily for 10 days and followed-up. The dermoscopic and histopathological findings were consistent with the diagnosis of acral AN and thus a final diagnosis of acral AN superimposed with vitamin B12 deficiency was made. This case is being reported due to its rare occurrence in the Indian population, the atypical clinical presentation of AN in form of macules and to highlight dermoscopy as an essential non invasive tool aiding in the diagnosis. The diagnosis of acral AN should not be overlooked despite the finding of low serum vitamin B12 levels in such a case and the authors wish to create awareness among the clinicians to investigate the patient further.

PSUN315 Elevated Serum B12 Levels are Associated with Diabetes

Abstract Background Vitamin B12 is an essential nutrient found in diverse food sources. Prokaryotic beings are capable of production through de novo aerobic and anaerobic biochemical reactions. It is common wisdom that diabetics, especially those receiving metformin, have vitamin B12 deficiency. However, little is known about the relationship between B12 levels and glucose tolerance. Methods A retrospective analysis of vitamin B12 levels and glucose tolerance in a representative U.S. population was performed. Records from the 2011-2014 National Health and Nutrition Examination Survey were reviewed. Individuals over the age of 20 were grouped according to a history of diabetes, Hb A1c levels, and fasting or 2-hour glucose tolerance test results into normal glucose (NG), abnormal glucose tolerance (AGT), and diabetes. A total of 19, 931 individuals were identified. Sample weighted analyses were performed with adjustment for the covariates of age, gender, body mass index, race/ethnicity, education, poverty index, current smoking, current alcohol consumption, family history of diabetes, vitamin B12 intake, and metformin use. Results Serum vitamin B12 levels were significantly higher among individuals with diabetes compared to those defined as AGT and NGT patients (496±14, 453±6, and 443±8 pmol/L, mean ± SE respectively, P=0.004). Diabetic individuals taking metformin had significantly lower serum vitamin B12 levels than diabetics not using metformin (445±16 vs. 518±13 pmol/L, P=0.0005). After exclusion of metformin users, diabetic subjects still had significantly higher serum vitamin B12 levels than NGT and AGT individuals (498±15, 456±6, and 445±8 pmol/L, respectively, P=0.006). The frequency of vitamin B12 supplement use was similar among diabetic, NGT, and AGT subjects (31%, 33%, and 31%, respectively, P=0.30). Likewise, the quantity of vitamin B12 supplementation was similar among the groups (233±34, 189±18, 192±24 mcg/day, respectively, P=0.50). Summary Retrospective analysis found higher serum B12 levels in diabetics compared to individuals with abnormal and normal glucose homeostasis. This novel finding was not secondary to exogenous B12 supplementation in diabetic individuals. Not unexpectedly, in individuals with diabetes, metformin exerted a negative effect on B12 levels. While the causes of elevated B12 in these individuals remain unknown, analysis of the intestinal bacterial flora and metabolome may be warranted. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Comparison of Serum Vitamin B12 Levels Among Drug-Naïve and Metformin-Treated Patients With Polycystic Ovary Syndrome.

Background Metformin is frequently prescribed for polycystic ovary syndrome (PCOS). There is a well-established causal relationship between metformin use in type 2 diabetes and vitamin B12 deficiency; such a relationship is seldom studied in PCOS. We conducted this study to compare vitamin B12 levels among newly diagnosed and metformin-treated patients with PCOS. Methodology This cross‑sectional comparative study was conducted from July 2021 to June 2022, among patients with PCOS attending a specialized endocrinology clinic of a tertiary hospital in Mymensingh, Bangladesh. A total of 50 patients newly diagnosed with PCOS and 52 with PCOS who had received metformin for at least six months were evaluated. The serum vitamin B12 level was measured by utilizing the chemiluminescent microparticle immunoassay principle. Results The new drug-naïve and metformin-treated subjects with PCOS had similar clinical and laboratory parameters except for the metformin group's lower hemoglobin levels and higher plateletcrit. Metformin receivers had lower serum vitamin B12 levels than the drug-naïve subjects (385.5 pg/mL [interquartile range, or IQR, 298.7-535.2] vs. 272.0 pg/mL [IQR 217.0-395.7];P< 0.001). The metformin group had higher frequencies of B12 deficiency and borderline deficiency (15.4% vs. 6% and 42.3% vs. 18%, respectively; P= 0.003). Conclusions This study observed lower serum B12 levels in PCOS patients using metformin than in the newly diagnosed ones. Large-scale data are needed to recommend routine periodic screening for B12 levels in metformin-treated PCOS.

Serum ferritin level and B12 in a sample of Iraqi re-current aphthous stomatitis patients

Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal disorders with a prevalence of 50-66%. The prevalence of hematinic deficiencies including ferritin and vitamin B12 deficiencies and their role in the prophylaxis and development of RAS is not well known. Many studies have demonstrated a high prevalence of hematinic deficiencies in patients with RAS. This study aimed to compare the serum level of ferritin and vitamin B12 in patients with recurrent aphthous ulcers and healthy controls. Subjects, Materials and Methods: The data were collected from patients who needed blood analysis to exclude anemia from November 2020 to May 2021. The study was approved by the institutional ethics committee. After recording patients' demographics ( age, gender, occupation, address) 5ml of blood was drawn from patients and controls in educational laboratories centrifuged at 3000 rpm for 10 minutes, then serum was stored at -20°C till the time of assessment of both serum ferritin and vitamin B12. The data were expressed as Mean ± SD. Students Unpaired t-test was used for comparing biochemical parameters between patients and controls and a p-value of &lt;0.05 was considered as a statistically significant while a p-value of&lt;0.001 was considered highly statistically significant. Results: A total of 30 RAS patients and 30 healthy control with age and gender matches were included. In the present study statistically, significant differences were observed in the serum level of ferritin and vitamin B12 between the two groups, 40% of the patients had low serum ferritin levels and 56.6 % of the patients had low serum vitamin B12 levels. Conclusion: Measuring serum ferritin and vitamin B12 levels are necessary for patients with recurrent aphthous stomatitis. It is also important for recurrent aphthous ulcer patients to have a nutritional diet containing iron and vitamin B12 to prevent the recurrence of aphthous ulceration

W230 Association between low serum Vitamin B12 and high folate level in pregnant women with gestational diabetes mellitus

W230 Association between low serum Vitamin B12 and high folate level in pregnant women with gestational diabetes mellitus

Lower Levels of Vitamin B12 Among Patients with Viral Warts Compared with Control Subjects: A Retrospective Study

Aim: Viral wart is a common benign infectious dermatosis. It remains unclear why not everyone exposed to HPV develops warts. It is known that vitamin and mineral deficiencies can affect impair natural and acquired immunity and lead to a tendency to get more infections. This study aimed to determine the potential utility of evaluating vitamin B12, folic acid, and ferritin levels in patients with viral warts. Material and Methods: In this retrospective study, 70 patients who were diagnosed with viral warts in the dermatology outpatient clinic of Karabük University Training and Research Hospital between January 2018 and December 2019 were included. 70 healthy individuals matched with viral wart patients in terms of gender and age were included as the control group. Serum vitamin B12, folic acid, and ferritin levels of both groups were detected and compared from the hospital automation system. Results: Vitamin B12 level was detected statistically significantly lower in the viral wart group as compared to the control group (p=0.046). Although serum ferritin levels were found lower in the viral wart group, this difference was not statistically significant (p=0.677). No statistically significant difference was detected between the viral wart and control groups in terms of folate levels (p=0.879). Conclusion: In patients with viral warts with low serum vitamin B12 levels, replacement therapy could be considered. Also, the evaluation of serum ferritin level, an iron storage parameter in the body, is important in patients with viral warts infection.

Comparison of Serum Holotranscobalamin with Serum Vitamin B12 in Population Prone to Megaloblastic Anemia and their Correlation with Nerve Conduction Study.

Early detection of megaloblastic anemia and associated neurological complications is crucial for management. This study was conducted to compare serum holotranscobalamin level with serum vitamin B12 level as early biomarker in people prone to megaloblastic anemia and to evaluate co-relation between these biomarkers and nerve conduction study in study patients. 83 adult patients (Hb > 12 gm/dl) prone to megaloblastic anemia were studied for basic haematological investigations, random blood sugar, thyroid function test, liver function test, kidney function test, serum vitamin B12, serum holotranscobalamin and serum folic acid levels. 45 patients among them underwent nerve conduction studies. All study patients were classified in 6 groups on the basis of risk factors for megaloblastic anemia. 29 patients (34.9%) were on antiepileptic drugs, 26 (31.3%) were chronic alcoholic, 10 patients (12%) each, had malabsorption and ileal tuberculosis, 6 (7.22%) had chronic pancreatitis and 2 (2.4%) had ileal resection. 30 patients (36.14%) had low serum holotranscobalamin, including 7 patients (8.43%) with low serum vitamin B12 level also, unmasking vitamin B12 deficiency in 23 patients (27.7%). 7 patients (8.43%) had mean corpuscular volume (MCV) > 100fL and 8 patients (9.63%) had vitamin B12 deficiency related changes on peripheral smear. Serum vitamin B12 and holotranscobalamin levels were significantly low in patients with peripheral smear changes, with p value 0.039 and 0.041 respectively, while no such association seen with MCV. Subclinical peripheral neuropathy was detected in 18 (40%) out of 45 patients on nerve conduction study. Serum holotranscobalamin levels were significantly lower (p = 0.031) than serum vitamin B12 levels (p = 0.2) in patients with neuropathic changes. Rest investigations and serum folic acid levels were normal in all patients. Holotranscobalamin levels can be considered early and reliable marker for vitamin B12 deficiency and deficiency associated peripheral neuropathy, even in patients who are prone to megaloblastic anemia, and not yet anemic or symptomatic for neuropathy.

Vitamin B12 deficiency is associated with narcolepsy

BackgroundNarcolepsy can be defined as a sleep disorder. However, whether changes in the serum vitamin B12 levels are involved in the pathophysiological mechanism of narcolepsy remains unclear. Our study aimed to assess whether vitamin B12 levels are independently related to the occurrence of narcolepsy. MethodsThe serum folate, vitamin B12, and homocysteine levels of 40 patients with narcolepsy and 40 age- and gender-matched healthy controls (HC) were retrospectively analyzed. According to the results of the univariate logistic analysis, a multiple logistic regression model was constructed to predict the independent influencing indicators. ResultsSerum folic acid and vitamin B12 levels in the narcolepsy group were significantly reduced. Moreover, through the sex subgroup, males in the narcolepsy group had lower serum vitamin B12 levels. Multivariate logistic regression revealed serum vitamin B12 to be independently associated with narcolepsy (p < 0.05; odds ratio=0.97; 95% confidence interval: 0.95–0.98). ConclusionDecreased serum vitamin B12 levels are independently associated with the development of narcolepsy, which illustrates the complex relationship between vitamin B12 and narcolepsy. Future studies should explore whether vitamin B12 supplementation can improve the symptoms of patients.

Effect of milk supplementation on the status of micronutrients among rural school children aged 5–19 years in a tribal predominating district of India

BackgroundIn the tribal state of Jharkhand, there have been very few studies on micronutrient deficiency and how it is addressed among school children. This study was conceived and undertaken to...

Determination of B Vitamins by Double-Vortex-Ultrasonic Assisted Dispersive Liquid-Liquid Microextraction and Evaluation of their Possible Roles in Susceptibility to COVID-19 Infection: Hybrid Box-Behnken Design and Genetic Algorithm.

In this study, double-vortex-ultrasonic assisted dispersive liquid-liquid microextraction (DVUDLLME) was applied to determine the concentration of vitamin B9, 5-methyl tetrahydrofolate (5-MeTHF) and vitamin B12 in human serum samples. High-performance liquid chromatography (HPLC) coupled with DVUDLLME was applied to analyze vitamins B in patients with Coronavirus disease (COVID-19). Then, significant variables were chosen and optimized using the hybrid Box-Behnken design and genetic algorithm. The detection limits of DVUDLLME-HPLC were 0.21ngmL-1, 0.18ngmL-1 and 55 pgmL-1 for vitamin B9, 5-MeTHF and vitamin B12, respectively. Subsequently, DVUDLLME-HPLC was applied to measure B vitamins and investigated their possible roles in susceptibility to COVID-19 infection. Fifty-seven percent of the patients without an underlying disease have significantly lower serum vitamin B12 levels in comparison to controls. The advantages of this method are low detection limit, simple preparation, low retention time and the use of a cheaper technique instead of expensive mass detectors. The results suggest that vitamin B12 deficiency may decrease the immune system defenses against COVID-19 patients without an underlying disease and cause the disease to become severe. However, these works need a large population and further research, such as a randomized trial and a cohort study.

Взаємозв’язок між прийомом метформіну й дефіцитом вітаміну В12 у хворих на цукровий діабет 2-го типу

Метформін — один з найпоширеніших антигіперглікемізуючих препаратів. До небажаних побічних ефектів його використання належить порушення обміну вітаміну В12, що асоціюється зі зниженням рівнів В12 у сироватці крові. Гіповітаміноз B12 у більшості випадків супроводжується периферичною полінейропатією й при тривалому прийомі метформіну може призводити до анемії, підвищення ризику депресії, цереброваскулярних і нейродегенеративних захворювань. Клінічні дослідження й метааналізи підтверджують взаємозв’язок прийому метформіну і гіповітамінозу В12. Встановлено, що підвищення рівня B12 на кожні 25 пмоль/л асоціюється зі зниженням ризику нейропатії на 6 %. Додаткове призначення препаратів вітаміну В12 сприяє компенсації спричинених метформіном порушень обміну цього вітаміну.

Prevalence of Vitamin B12 Deficiency among Exclusively Breast Fed term infants

Objective: To determine the rate of vitamin B 12 deficiency among exclusively breast fed term infants in central Punjab Method: This descriptive case series included all 120 exclusively breast fed, term, and healthy infants with age range 1-6 months at Children, Hospital, Lahore. The maternal socio-demographic details in addition to infants’ anthropometric measurements were recorded and CBS and serum Vit B12 levels were evaluated by sending the samples to the hospital lab. We used SPSS 16th vesion for data analysis. Results: Mean age of the infants was 3.25+1.47 months. 58.33%(n=70) were male and 41.67%(n=50) were female infants. The mean serum vitamin B12 levels were recorded as 196.81 (±121.432)pg/mL. Frequency of low vitamin B12 (&lt;200 pg/ml)in infants was recorded in Low serum vitamin B12 levels (&lt;200 pg/ml) was seen in 66 (55%) of infants. Conclusion: The rate of vit B12 deficiency is higher in EBF infants and due to its an important role in neurologic development during infancy, it is necessary to address this issue in infants

Life-threatening Pseudo-thrombotic Microangiopathy Caused by Severe Vitamin B12 Deficiency

Vitamin B12 deficiency is a common cause of macrocytic anemia. Life-threatening hematologic complications including immune and non-immune hemolytic anemia are present in about 10% of the cases. Pseudo-thrombotic microangiopathy is an extremely rare presentation found in around 2.5% of patients with vitamin B12 deficiency. We present a case of a 70-year-old male patient who presented with progressive fatigue and syncope. He was found to severe macrocytic anemia with hemoglobin of 4.1 g/dL. Further workup showed very low serum vitamin B12 level at 22 pg/mL (normal 180-914), methylmalonic acid of 93.23 umol/L (normal 0-0.4) and homocysteine of 93 umol/L (normal 4-12). Anti-parietal cell and intrinsic factor blocking antibodies were positive. He was noted as well to have thrombocytopenia, low haptoglobin, increased lactate dehydrogenase and increased serum creatinine. Peripheral blood smear showed schistocytes, hyper-segmented neutrophils, and marked dimorphic anemia. His presentation was concerning for thrombotic thrombocytopenic purpura; however, PLASMIC score was intermediate. He was monitored in the intensive care unit. He received supportive treatment with intravenous hydration and packed red blood cells transfusion. He was started on daily intramuscular cyanocobalamin supplements. Significant improvement in his symptoms with near normalization of complete blood count after one month of treatment was noted. His condition improved without the need for plasmapheresis.

Association of low vitamin B12 in Trigeminal Neuralgia Patients Visiting Peshawar Dental College

Background: Vitamin B12 is also known as cobalamin and is a hydrophilic vitamin, it is involved in metabolism of every cell of the body. It is a cofactor in DNA synthesis RNA, hormones, proteins, and lipids, and in both fatty acid and amino acid metabolism. Low levels of serum vitamin B12 may trigger pain in patients suffering from trigeminal neuralgia. Methylcobalamin, a form of Vitamin B12, protects against neurological diseases and aging. Mauro showed that high doses of methylcobalamin are needed to regenerate neurons as well as the myelin sheath that protects nerve axons and the peripheral nerves.Objective: The prime focus of this study was to report the frequency of low serum Vitamin B12 level in Identified Trigeminal Neuralgia patients visiting Peshawar Dental College and Hospital and to find the effect of gender on low serum vitamin B12 levels.Methods: A total of 90 known trigeminal neuralgia patients seeking treatment at the Department of Oral Medicine, Peshawar Dental College and Hospital were enrolled. All patients were advised to carry out serum Vitamin B12 level in laboratory. Data were analyzed by SPSS version 19. The statistical significance was set up at p &lt;0.05.Results: Out of 90 known trigeminal neuralgia patients, 58.8% were females and 41.1% were males. 43.3% females and 27.0%males had low serum Vitamin B12 levels. No statistical significant difference between gender and low serum vitamin B12 level was found.Conclusions: Study confirms that gender has no effect on low serum levels of B12 in trigeminal neuralgia patients and a highproportion of trigeminal neuralgia patients had a low serum vitamin B12 levels.