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Prevalence and haemopoietic effects of low serum vitamin B12 levels in geriatric medical patients

Published online by Cambridge University Press:  09 March 2007

David J. Stott
Affiliation:
Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow
Peter Langhorne
Affiliation:
Department of Geriatric Medicine, Gartnavel General Hospital, Glasgow
Anne Hendry
Affiliation:
Department of Geriatric Medicine, Gartnavel General Hospital, Glasgow
Pamela J Mckay
Affiliation:
Department of Haematology, Western Infirmary, Glasgow
Tessa Holyoake
Affiliation:
Department of Haematology, Western Infirmary, Glasgow
Jon Macdonald
Affiliation:
Department of Geriatric Medicine, Gartnavel General Hospital, Glasgow
Norman Lucie
Affiliation:
Department of Haematology, Western Infirmary, Glasgow
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Abstract

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The clinical significance of low serum vitamin B12 levels in elderly people is controversial. We aimed to document the prevalence of a low serum vitamin B12 (<175pmol/l) in patients referred to a geriatric medical unit, and to determine whether haemopoiesis is commonly affected in elderly patients with low serum vitamin B12. We studied prospectively 472 consecutive referrals to a geriatric medical unit; fifty-six (13%) had a low serum vitamin B12 level, of whom nineteen (34%) of the fifty-six also had evidence of Fe deficiency (serum ferritin<45ng/ml). Low vitamin B12 was associated with a raised mean erythrocyte volume (MCV; mean 96·0 (SD 6·7) fl), compared with a control group (91·7 (SD 6·0) fl; P=0·001). However, only thirteen (23%) of the fifty-six patients with a low vitamin Blz had an MCV≥100 fl. Mean haemoglobin (Hb) levels were not significantly reduced in those with a low vitamin B12. In a subsequent study the haematological response to intramuscular hydroxocobalamin was examined in thirty-four patients with a low serum vitamin B12. Treatment resulted in a significant fall in MCV and rise in Hb; these effects could be detected both in those patients with an initially normal full blood count (change in MCV -1·2 (SD 1·2); Hb + 0·5 (SD 0·6); P<0·01) and in those with macrocytosis and/or anaemia (-9·1 (SD 11·8); + 0·8 (SD 1·2); P<0·05). A low serum vitamin B12 is common in geriatric medical patients. This is usually associated with an upset in erythropoiesis, although the abnormalities are often subtle and may not be apparent on inspection of the full blood count. Elderly patients with serum vitamin B12<175pmol/l should be assumed to have vitamin deficiency even if their full blood count is normal.

Type
Human and Clinical Nutrition
Copyright
Copyright © The Nutrition Society 1997

References

REFERENCES

Anderson, B. B. (1964). Investigations into the Euglena method for the assay of the vitamin B12 in serum. Journal of Clinical Pathology 17, 1421.Google Scholar
Atrah, H. I. & Davidson, R. J. (1988). Iron deficiency in pernicious anaemia: a neglected diagnosis. Postgraduate Medical Journal 64, 110111.Google Scholar
Basun, H., Fratiglioni, L. & Winblad, B. (1994). Cobalamin levels are not reduced in Alzheimer's Disease: results from a population-based study. Journal of the American Geriatrics Society 42, 132136.Google Scholar
Boddy, K., Douglas, A. S. & Adams, J. F. (1972). Interrelation of serum vitamin B12, total body vitamin B12, peripheral blood morphology and the nature of erythropoiesis. British Journal of Haemutology 23, 297305.Google Scholar
Carmel, R. & Karnaze, D. S. (1985). The deoxyuridine suppression test identifies subtle cobalamin deficiency in patients without typical megaloblastic anaemia Journal of the American Medical Association 253, 12841287.Google Scholar
Carmel, R., Sinow, R. M. & Karnaze, D. S. (1987 a). Atypical cobalamin deficiency: subtle biochemical evidence of deficiency is commonly demonstrable in patients without megaloblastic anaemia and is often associated with protein-bound cobalamin malabsorption. Journal of Laboratory Clinical Medicine 109, 454463.Google Scholar
Carmel, R., Weiner, J. M. & Johnson, C. S. (1987 b). Iron deficiency occurs frequently in patients with pernicious anemia. Journal of the American Medical Association 257, 10811083.Google Scholar
Casale, G., Bonora, C., Migliavacca, A., Zurita, I. E. & de Nicola, P. (1981). Serum ferritin and ageing. Age and Ageing 10, 119122.Google Scholar
Fairbanks, V. F. (1983). Test for pernicious anaemia: the ‘Schilling test’. Mayo Clinic Proceedings 58, 541544.Google Scholar
Guyatt, G. H., Patterson, C., Ali, M., Singer, J., Levine, M., Turpie, I. & Meyer, R. (1990). Diagnosis of iron-deficiency anemia in the elderly. American Journal of Medicine 88, 205209.Google Scholar
Harker, L. A., Ross, R., Slichter, S. I. & Scott, C. R. (1976). Homocystine-induced arteriosclerosis: the role of endothelial cell injury and platelet response in its genesis. Journal of Clinical Investigation 58, 731741.Google Scholar
Heinecke, J. W., Rosen, H., Suzuki, L. A. & Chait, A. (1987). The role of sulfur-containing amino acids in superoxide production and modification of low density lipo-protein by arterial smooth muscle cells. Journal of Biological Chemistry 262, 1009810099.Google Scholar
Hoffbrand, A. V., Newcombe, B. F. A. & Mollin, D. L. (1966). Method of assay of red cell folate activity and the value of the assay as a test for folate deficiency. Journal of Clinical Pathology 19, 1728.Google Scholar
Holyoake, T. L., Stott, D. J., McKay, P. J., Hendry, A., MacDonald, J. B. & Lucie, N. P. (1993). Use of plasma ferritin level to diagnose iron deficiency in elderly patients. Journal of Clinical Pathology 46, 857860.Google Scholar
Hughes, D., Elwood, R. C., Shinton, N. K. & Wrighton, R. J. (1970). Clinical trial of the effect of vitamin B12 in elderly subjects with low serum B12 levels. British Medical Journal 2, 458460.Google Scholar
Kang, S. S., Wong, P. W. & Malinow, M. R. (1992). Hyperhomocyst(e)inemia as a risk factor for occlusive vascular disease. Annual Review of Nutrition 12, 279298.Google Scholar
Karnaze, D. S. & Carmel, R. (1990). Neurologic and evoked potential abnormalities in subtle cobalamin deficiency states, including those without anaemia and with normal absorption of free cobalamin. Archives of Neurology 47, 10081012.Google Scholar
Kristensen, M. O., Gulmann, N. C., Christensen, J. E. J., Ostergaard, K. & Rasmussen, K. (1993). Serum cobalamin and methylmalonic acid in Alzheimer dementia. Acta Neurologica Scandinavica 87, 475481.Google Scholar
Langhorne, P., Hendry, A., MacDonald, J. B., MacKay, P., Holyoake, T., Lucie, N. & Stott, D. J. (1992). Screening for vitamin B12 and folate deficiency in geriatric medical patients. Age and Ageing 21 Suppl. 2, 15 Abstr.Google Scholar
Lindenbaum, J., Healton, E. B., Savage, D. G., Brust, J. C. M., Garrett, T. J., Podell, E. R., Marcell, P. D., Stabler, S. P. & Allen, R. H. (1988). Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. New England Journal of Medicine 318, 17201728.Google Scholar
Lindenbaum, J., Rosenberg, I. H., Wilson, P. W. F., Stabler, S. P. & Allen, R. H. (1994). Prevalence of cobalamin deficiency in the Framingham elderly population. American Journal of Clinical Nutrition 60, 211.Google Scholar
Logan, R. F., Elwis, A., Forrest, M. J. & Lawrence, A. C. (1989). Mechanisms of vitamin B12 deficiency in elderly inpatients. Age and Ageing 18, 410.Google Scholar
Martin, D. C. (1988). B12 and folate deficiency dementia. Clinics in Geriatric Medicine 4, 841852.Google Scholar
Mattila, K. S., Kuusela, V., Pelliniemi, T. T., Rajamaki, A., Kaihola, H. L. & Juva, K. (1986). Haematological laboratory findings in the elderly: influence of age and sex. Scandinavian Journal of Clinical and Laboratory Investigation 46, 411415.Google Scholar
McKay, P. J., Stott, D. J., Holyoake, T., Hendry, A., MacDonald, J. B. & Lucie, N. P. (1993). Use of the erythrogram in the diagnosis of iron deficiency in elderly patients. Acta Haematologica 89, 169173.Google Scholar
Mosbech, J. (1952). Incidence of pernicious anaemia. Acta Medica Scandinavica 141, 433439.Google Scholar
Pennypacker, L. C., Allen, R. H., Kelly, J. P., Matthews, L. M., Grigsby, T., Kaye, K., Lindenbaum, J. & Stabler, S. P. (1992). High prevalence of cobalamin deficiency in elderly outpatients. Journal of the American Geriatrics Society 40, 11971204.Google Scholar
Rogers, G. M. & Conn, M. T. (1995). Homocysteine, an atherogenic stimulus, reduces protein C activation by arterial and venous endothelial cells. Blood 75, 895901.Google Scholar
Savage, D. G. & Lindenbaum, J. (1995). Neurological complications of acquired cobalamin deficiency: clinical aspects. Balliere's Clinical Haematology 8, 457478.Google Scholar
Tefferi, A. & Pruthi, R. K. (1994). The biochemical basis of cobalamin deficiency. Mayo Clinic Proceedings 69, 181186.Google Scholar
Yelland, C. (1991). Disorders of the upper gastrointestinal tract. Reviews in Clinical Gerontology 1, 2942.Google Scholar