vitamin-b-12 and Anemia--Macrocytic

Anemia is a common problem in primary care. Classification based on mean cell volume narrows the differential diagnosis and directs testing. A marked macrocytosis is characteristic of vitamin B12 and folate deficiencies, certain medications, and primary bone marrow disorders. The three most common causes of microcytic anemia are iron deficiency, thalassemia trait, and anemia of inflammation. Additional laboratory testing is required for diagnosis. Determination of the rate of development of anemia and examination of a blood smear may provide diagnostic clues to guide more specialized testing. Diagnosis of iron, vitamin B12, or folate deficiency mandates determination of the underlying cause.

Topics: Alcohol Drinking; Anemia, Iron-Deficiency; Anemia, Macrocytic; Blood Cell Count; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Liver Diseases; Myeloproliferative Disorders; Predictive Value of Tests; Primary Health Care; United States; Vitamin B 12; Vitamin B 12 Deficiency; Women's Health

Pernicious anemia and Vitamin B12 deficiency have a wide range of symptoms and are a common finding in the elderly. A 73 year old female is admitted to the hospital because of dyspnea, fatigue and loss of appetite and weight. While previous medical history and physical examination are inconspicuous, laboratory findings show severe pancytopenia with macrocytosis, low reticulocyte count and marked signs of hemolysis. A very low serum level of vitamin B12 and chronic atrophic type A gastritis upon endoscopy with presence of parietal cell antibodies in the serum lead to the diagnosis of pernicious anemia. Complete restitution is achieved by parenteral vitamin B12 substitution. Nowadays, severe pernicious anemia is only rarely seen. The differential diagnosis of pancytopenia (with macrocytic anemia) combined with hemolysis and the essential hints to the diagnosis of pernicious anemia are discussed, and thereby practical aspects including therapy actualized.

Topics: Age Factors; Aged; Anemia, Macrocytic; Anemia, Pernicious; Diagnosis, Differential; Female; Folic Acid; Gastritis, Atrophic; Hemolysis; Humans; L-Lactate Dehydrogenase; Pancytopenia; Vitamin B 12

Topics: Adult; Aged; Alcoholism; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Humans; Hydroxocobalamin; Hypothyroidism; Infant, Newborn; Liver Failure; Male; Pregnancy; Risk Factors; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Functional methionine synthase deficiency due to abnormal methylcobalamin metabolism causes megaloblastic anemia, moderate to severe developmental delay, lethargy, and anorexia in association with homocystinuria. Patients with this disorder of cobalamin metabolism can be classified into two separate groups, cblE or cblG, primarily on the basis of complementation analysis with cultured skin fibroblasts. We describe two unrelated boys, ages 3 and 5 years, with the cblG defect in methylcobalamin synthesis. Both children presented with severe developmental delay, lethargy, anorexia, and megaloblastic anemia. The diagnosis of homocystinuria was delayed in each case due to difficulties with detection of small amounts of homocystine in physiologic samples. The clinical course of cblG disease is favorably altered by treatment with intramuscular hydroxycobalamin. Megaloblastosis in the presence of adequate supplies of cobalamin and folate in the blood must alert the clinician to the possibility of functional methionine synthase deficiency and should prompt a careful search for associated biochemical hallmarks, including homocystinuria/emia.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Anemia, Macrocytic; Anemia, Megaloblastic; Anorexia; Child, Preschool; Developmental Disabilities; Female; Fibroblasts; Genetic Complementation Test; Homocystine; Homocystinuria; Humans; Male; Methionine; Skin; Vitamin B 12

Macrocytic and/or megaloblastic anaemias of infants and children are more often due to a defective bone marrow production than to haemolysis. They are mostly related to folate and/or cobalamin deficiency or to a disturbance in the metabolism of one of these vitamins (enzyme deficiencies or defect of synthesis of their active forms). More rarely, these anaemias are associated with congenital deficiency of the enzymes involved in pyrimidine or purine biosynthesis. A few cases of thiamine-responsive megaloblastic anaemia have been reported. Some blood diseases may also associated with macrocytic anaemia. Finally, many drugs (antifolic agents, antipurine or antipyrimidine compounds) may induce macrocytic anaemia.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Infant; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Animals; Folic Acid; Formates; Humans; Macrophages; Rats; Tuberculosis; Vitamin B 12; Vitamin B 12 Deficiency

Developments relating to cobalamin and folate are reviewed. Current work on the relations between these two coenzymes are discussed, particularly those that have emerged in studies using nitrous oxide, which inactivates cobalamin.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Humans; Intestinal Absorption; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Child; Child, Preschool; Demyelinating Diseases; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Middle Aged; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

The diagnosis of megaloblastic anemia and the differentiation of folate and vitamin B12 deficiency require, in addition to careful attention to the history and physical findings, the use of laboratory tests. In this paper the commonly ordered tests for such a diagnosis are discussed, with emphasis on the conditions that may cause false-positive or false-negative results in the complete blood count, examination of a peripheral blood smear and a bone marrow specimen, serum and erythrocyte folate assays, serum vitamin B12 assays, tests of vitamin B12 absorption and gastric analysis.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Anemia, Sideroblastic; Biological Assay; Blood Cell Count; Bone Marrow Examination; Diagnostic Errors; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Lacticaseibacillus casei; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Aplastic; Anemia, Macrocytic; Antineoplastic Agents; Bone Marrow; Hematopoietic Stem Cells; Humans; Leukemia, Myeloid, Acute; Metaplasia; Preleukemia; Prognosis; Syndrome; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Anticonvulsants; Blood Cell Count; Child, Preschool; Contraceptives, Oral; Diagnosis, Differential; Diet; Erythropoiesis; Ethanol; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Male; Medical History Taking; Methionine Adenosyltransferase; Vitamin B 12; Vitamin B 12 Deficiency

The three most common causes of macrocytosis--vitamin B12 or folate deficiency, liver disease, and reticulocytosis--usually can be differentiated on the basis of red cell indexes and morphologic findings. Bone marrow studies are not indicated. In reticulocytosis, the mean corpuscular volume (MCV) rarely exceeds ll0 cu mu and a reticulocyte count quickly establishes the diagnosis. In liver disease, macrocytosis is also mild and uniform. The RBCs are round. In megaloblastic anemia, the MCV may exceed 150 cu mu. The RBCs vary considerably in size and shape. The macrocytes tend to be oval. Serum vitamin B12 determination remains the best test for unmasking vitamin B12 deficiency. It should be ordered in conjunction with serum and red cell folate determinations in the course of investigating a macrocytic anemia. When vitamin B12 deficiency has been established, a Schilling test or plasma uptake test is indicated to pinpoint the cause.

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Sideroblastic; Clinical Laboratory Techniques; Erythrocytes; Folic Acid; Humans; Liver Diseases, Alcoholic; Male; Radioisotopes; Schilling Test; Vitamin B 12

Topics: Alcoholism; Anemia, Macrocytic; Anemia, Megaloblastic; Anti-Bacterial Agents; Anticonvulsants; Antimetabolites, Antineoplastic; Contraceptives, Oral; Drug-Related Side Effects and Adverse Reactions; Folic Acid Antagonists; Humans; Malabsorption Syndromes; Pyrimethamine; Triamterene; Trimethoprim; Vitamin B 12

Topics: Anemia; Anemia, Hemolytic; Anemia, Hemolytic, Congenital; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Sideroblastic; Chronic Disease; Diagnosis, Differential; Humans; Malabsorption Syndromes; Thalassemia; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Antibodies; Cobalt Radioisotopes; Deoxyuridine; Folic Acid; Humans; Intestinal Absorption; Intrinsic Factor; Isotope Labeling; Protein Binding; Radioimmunoassay; Transcobalamins; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anti-Bacterial Agents; Anticonvulsants; Antimetabolites; Contraceptives, Oral; Ethanol; Folic Acid; Folic Acid Antagonists; Humans; Intestinal Absorption; Purines; Pyrimidines; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Hemolytic; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Biological Transport; Bone Marrow; Bone Marrow Cells; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Homocystinuria; Humans; Infant; Intrinsic Factor; Malabsorption Syndromes; Male; Metabolism, Inborn Errors; Methionine; Methionine Adenosyltransferase; Orotic Acid; Phenylketonurias; Tetrahydrofolate Dehydrogenase; Transcobalamins; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Animals; Cell Division; Euglena gracilis; Folic Acid; Folic Acid Deficiency; Humans; Leukemia; Methylation; Nucleic Acids; Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid Deficiency; Humans; India; Infant; Infant, Newborn; Infant, Premature; Lactation; Nutritional Physiological Phenomena; Nutritional Requirements; Pregnancy; Pregnancy Complications, Hematologic; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Ascorbic Acid; Chemical Phenomena; Chemistry; Child, Preschool; Digestive System; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Intestinal Absorption; Iron; Male; Pregnancy; Riboflavin; Vitamin B 12

Topics: Alcoholism; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Diagnosis, Differential; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Pyrimidine Nucleotides; Thymine Nucleotides; Uracil Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anticonvulsants; Contraceptives, Oral; DNA; Drug-Related Side Effects and Adverse Reactions; Erythrocytes; Ethanol; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Nucleotidyltransferases; Purines; Pyrimidines; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bile; Binding Sites; Feces; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intrinsic Factor; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sickle Cell; Child; Child, Preschool; Feces; Female; Fever; Folic Acid; Hemoglobinopathies; Hookworm Infections; Humans; Infant; Leishmaniasis, Visceral; Malaria; Male; Pregnancy; Protozoan Infections; Schistosomiasis; Vitamin B 12

Topics: Anemia, Macrocytic; Deoxyuridine; DNA; Erythrocytes, Abnormal; FIGLU Test; Folic Acid Deficiency; Homocysteine; Humans; Methionine; Nervous System Diseases; Tetrahydrofolate Dehydrogenase; Tetrahydrofolates; Thymine Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Animals; Body Weight; Folic Acid; Humans; Ileum; Intestinal Absorption; Intrinsic Factor; Liver; Receptors, Drug; Schilling Test; Sprue, Tropical; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Animals; Biological Assay; Blood Proteins; Cobalt Isotopes; Euglena gracilis; Evaluation Studies as Topic; Folic Acid Deficiency; Gastrectomy; Humans; Lactobacillus; Methods; Protein Binding; Radioisotope Dilution Technique; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Antigens; Autoantibodies; Biopsy; Chronic Disease; Cytoplasm; Digestive System; Female; Fluorescent Antibody Technique; Gastric Juice; Gastric Mucosa; Gastritis; Humans; Immunologic Deficiency Syndromes; Intrinsic Factor; Lipoproteins; Microsomes; Schilling Test; Stomach; Vitamin B 12

Topics: Anemia, Macrocytic; Complement System Proteins; Erythropoietin; Folic Acid; Humans; Leukemia; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Coenzymes; Humans; Intestinal Absorption; Intrinsic Factor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Biological Transport; Diet; Female; Folic Acid; Folic Acid Deficiency; Food; Hematopoiesis; Humans; Intestinal Absorption; Iron; Male; Pregnancy; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Animals; Folic Acid; Folic Acid Deficiency; Humans; Liver; Methionine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amino Acids; Anemia, Macrocytic; Contraceptives, Oral; Diet; DNA; Ethanol; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Glycine; Homocysteine; Humans; Malabsorption Syndromes; Methionine; Pharmacology; Serine; Toxins, Biological; Vitamin B 12

Topics: Anemia, Macrocytic; Clinical Laboratory Techniques; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Bacteria; Carbohydrate Metabolism; Celiac Disease; Humans; Intestinal Absorption; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Lipid Metabolism; Proteins; Vitamin B 12

Topics: Anemia; Anemia, Hemolytic; Anemia, Hemolytic, Congenital Nonspherocytic; Anemia, Hypochromic; Anemia, Macrocytic; Blood Transfusion; Erythropoiesis; Glucocorticoids; Humans; Iron; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Blood Cell Count; Feces; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Milk; Milk, Human; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Arthritis, Rheumatoid; Bone Marrow; Cobalt; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Hemoglobinometry; Humans; Intestinal Absorption; Iron; Liver Extracts; Male; Mononuclear Phagocyte System; Plasma Volume; Potassium; Salicylates; Sex Factors; Steroids; Vitamin B 12

Topics: Anemia, Macrocytic; Anticonvulsants; Electroconvulsive Therapy; Electroencephalography; Epilepsy; Folic Acid; Folic Acid Deficiency; Humans; Mental Disorders; Methionine; Phenethylamines; Phenothiazines; Schizophrenia; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Bacteria; Bone Marrow; Bone Marrow Cells; Carcinoma, Hepatocellular; Chemical Phenomena; Chemistry; DNA Replication; Enzyme Repression; Erythropoiesis; Escherichia coli; Humans; In Vitro Techniques; Kinetics; Liver; Liver Neoplasms; Microscopy, Phase-Contrast; Models, Chemical; Nucleotides; Oxidoreductases; Phosphorus Isotopes; Rats; RNA; Time Factors; Tritium; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Chronic Disease; Hemoglobinometry; Hemolysis; Humans; Liver; Liver Cirrhosis; Liver Diseases; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Child, Preschool; Gastric Mucosa; Humans; Ileum; Infant; Infant, Newborn; Intestinal Mucosa; Intrinsic Factor; Kidney; Malabsorption Syndromes; Proteinuria; Urogenital Abnormalities; Vitamin B 12

Topics: Adult; Anemia, Hemolytic; Anemia, Macrocytic; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Cell Count; Bone Marrow Cells; Erythrocytes; Erythropoiesis; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemolysis; Hemorrhagic Disorders; Humans; Iron; Leukocytes; Liver; Reticulocytes; Scurvy; Tissue Extracts; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Abetalipoproteinemia; Adult; Anemia; Anemia, Macrocytic; Animals; Ascorbic Acid; Bone Marrow; Deficiency Diseases; Dietary Fats; DNA Replication; Erythropoiesis; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Iron; Kwashiorkor; RNA; Salmonidae; Selenium; Swine; Vitamin B 12; Vitamin E; Vitamin E Deficiency

Topics: Achlorhydria; Anemia, Macrocytic; Anemia, Pernicious; Child, Preschool; Gastric Juice; Humans; Male; Methods; Proteinuria; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Animals; Folic Acid; Humans; Intestinal Atresia; Rats; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Carbohydrate Metabolism; Dumping Syndrome; Gastroenterostomy; Hematopoiesis; Humans; Intestinal Absorption; Intrinsic Factor; Iron; Malabsorption Syndromes; Methods; Postgastrectomy Syndromes; Protein-Losing Enteropathies; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Celiac Disease; Diagnosis; Diarrhea; Humans; Intestinal Obstruction; Intestine, Small; Intestines; Physiology; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Blood Platelets; Eosinophilia; Epoetin Alfa; Erythropoietin; Humans; Iron; Leukemia; Polycythemia Vera; Vitamin B 12

Topics: Altitude; Anemia; Anemia, Macrocytic; Anemia, Sickle Cell; Ascorbic Acid; Celiac Disease; Climate; Deficiency Diseases; Female; Folic Acid; Hematology; Humans; Infant; Metabolism; Nutrition Disorders; Parasitic Diseases; Pharmaceutical Preparations; Poisons; Polycythemia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Radiation Effects; Seasons; Sprue, Tropical; Vitamin B 12

Topics: Absorption; Anemia; Anemia, Macrocytic; Biological Assay; Carbon Isotopes; Chromatography; Clinical Enzyme Tests; Clinical Laboratory Techniques; Coenzymes; Corrinoids; Deficiency Diseases; Electrophoresis; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formates; Histidine; Humans; Male; Metabolism; Tritium; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Coenzymes; Erythropoiesis; Folic Acid; Humans; Metabolism; Research; Vitamin B 12

Topics: Adrenal Insufficiency; Anemia; Anemia, Aplastic; Anemia, Macrocytic; Conjunctivitis; Electrocardiography; Folic Acid; Heart Failure; Hepatitis; Hypertrichosis; Hypopituitarism; Hypothalamus; Leukopenia; Lymph Nodes; Metabolism; Methemoglobinemia; Pharmacology; Phenytoin; Pulmonary Fibrosis; Thrombocytopenia; Thyroid Function Tests; Toxicology; Vitamin B 12

There is limited literature in children on efficacy of different routes of vitamin B12 administration for vitamin B12 deficiency macrocytic-megaloblastic anemia.. To compare parenteral with oral vitamin B12 therapy in children with macrocytic-megaloblastic anemia.. Single-center, open-label randomized controlled trial.. 80 children aged 2 month-18 year with clinical and laboratory features of nutritional macrocytic anemia.. All children received an initial single parenteral dose of 1000 µg vitamin B12 followed by randomization to either parenteral or oral vitamin B12 for subsequent doses. Group A was given 1000 µg intramuscular (IM) vitamin B12 (3 doses on alternate days for those aged <10 year, five doses for age >10 year), followed by monthly 1000 µg IM for the subsequent two doses. Group B was given daily oral vitamin B12 1500 µg (500 µg in <2 years age) for three months. Folic acid and iron supple-mentation, and relevant dietary advice were given to both groups in a similar fashion.. Improvement in serum vitamin B12 levels and total hemoglobin was compared three months post-treatment.. The median(IQR) increase in serum vitamin B12 level was significantly higher in group A [600 (389,775) vs 399 (313, 606) pg/mL; P= 0.016]. The median (IQR) rise of hemoglobin was also more in group A [2.7 (0.4,4.6) vs 0.5 (-0.1,1.2) g/dL; P=0.001].. Increase in serum vitamin B12 levels and hemoglobin was better in children with nutritional macrocytic anemia receiving parenteral as compared to oral vitamin B12.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Child; Folic Acid; Hemoglobins; Humans; Vitamin B 12; Vitamin B 12 Deficiency

There is an association between Alzheimer's disease (AD) and low serum levels of vitamin B12 and folic acid. Patients also have elevated serum levels of homocysteine and disease progression might therefore be associated with the development of a macrocytic anaemia. We investigated the relationship between disease duration, homocysteine and haematological indices in patients with clinically diagnosed AD and healthy elderly controls. Haemoglobin and platelet counts fell only slightly with increasing dementia duration, but there were no other changes in haematological indices. In particular, macrocytosis and red cell distribution width were unrelated to disease duration and no patients were anaemic. Our results support previous observations that the neurological and haematological features of B12 and folate deficiency are often unrelated in these patients.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Anemia, Macrocytic; Disease Progression; Female; Folic Acid; Homocysteine; Humans; Male; Platelet Count; Sex Factors; Vitamin B 12

Ninety-five patients who had megaloblastic anaemia, and who lived in a subtropical climate, were studied to elucidate the importance of puerperium, malabsorption, gastric dystrophy, diet and infection in the aetiology of the disease. All 5 factors were found to be common, and to occur in a variety of combinations, producing a wide spectrum of illness variously resembling nutritional megaloblastic anaemia, sprue, pernicious anaemia and many stages in between. It is concluded that megaloblastic anaemia in this population is a multifactorial disease, and a tentative scheme, relating the aetiological factors, is drawn up. Neither serum vitamin B(12) levels, nor folate estimation in serum or red cells emerged as very reliable guides to the underlying biochemical deficiency.

Topics: Adolescent; Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Clinical Trials as Topic; Double-Blind Method; Female; Folic Acid; Humans; Infections; Malabsorption Syndromes; Male; Tetracycline; Vitamin B 12

Fifty-three patients with megaloblastic anaemia treated with cyanocobalamin and folic acid have been studied. Repeat marrow examination was found to be of value in assessing response to treatment. The early improvement in marrow morphology in patients with pernicious anaemia was greater with 1000 mug than with 5 mug doses of cyanocobalamin. The effect of folate deficiency in delaying marrow response to cyanocobalamin in patients with pernicious anaemia is described and combined cyanocobalamin and folic acid treatment was found to be more effective than either alone. The response to large doses of cyanocobalamin in folate deficient patients was unrelated to the initial serum vitamin B12 level.

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Examination; Clinical Trials as Topic; Erythroblasts; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Time Factors; Vitamin B 12

Folic acid administered to pregnant Bantu, whose diet is low in folate, was associated with a significant reduction in the incidence of prematurity. No such effect could be demonstrated in White patients subsisting on an average Western diet. This suggests that folate deficiency may contribute to the "pregnancy wastage" in populations whose dietary folate intake is low, and is a further indication for folic acid supplementation during pregnancy in these groups.

Topics: Anemia, Macrocytic; Birth Weight; Black People; Diet; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Infant, Premature; Iron; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; White People

Topics: Anemia, Macrocytic; Female; Folic Acid; Humans; Intestinal Absorption; Intrinsic Factor; Pregnancy; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Clinical Trials as Topic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Anemia frequently occurs during course of clinical thyroid diseases. Without proper diagnosis & effective treatment of underlying thyroid disease, it is often difficult to achieve complete correction of anemia.. The present study was conducted to assess prevalence & types of anaemia in patients with thyroid disorders.. A cross sectional study was conducted on 160 patients including both hypothyroid & hyperthyroid patients at OPD/IPD in SRN Hospital affiliated to MLN Medical college Prayagraj between July 2021 & August 2022. Blood samples were taken to estimate CBC, GBP with Retic count, S. ferritin, S. folate, S. Vitamin B12, Thyroid profile. Data was entered in MS Excel Spreadsheet & appropriate statistical package applied.. Out of 144 hypothyroid patients, 102 (70.83%) were found to be anaemic & out of 16 hyperthyroid patients, 6 (37.5%) were found to be anaemic. In 102 anaemic hypothyroid patients, 56 (54.9%)had normocytic normochromic, 25 (24.5%) had microcytic and 21 (20.5%) had macrocytic anaemia. In 6 anaemic hyperthyroid patients, 3 (50%) had normocytic normochromic, 2(33.33%) had microcytic and 1 (16.67%) had macrocytic anaemia.. High prevalence of anaemia was found in patients with thyroid disorders. Anaemia is an uncommon finding in hyperthyroidism but when present may be similar to that present in hypothyroidism. The most common type of anaemia in both hyperthyroidism & hypothyroidism was found to be normocytic normochromic, followed by microcytic & least common being macrocytic. References Suhail N, Abu Alsel BT, Batool S. Prevalence and association of thyroid dysfunction with anemia/body iron status among northern border Saudi population. Int J Med Res Health Sci 2020;9(3):1-7. Peraka SA, Karre S, Ravuri S, et al., To evaluate prevalence of anemia in hypothyroid patients. J Diagn Pathol Oncol 2019;4(2):110-113.

Topics: Anemia; Anemia, Macrocytic; Cross-Sectional Studies; Ferritins; Folic Acid; Humans; Hyperthyroidism; Hypothyroidism; Thyroid Diseases; Thyroid Hormones; Vitamin B 12

Topics: Anemia, Macrocytic; Cell Lineage; Erythroblasts; Humans; Infant; Megakaryocytes; Transcobalamins; Vitamin B 12

Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia.. To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children.. These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members.. We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

Topics: Adolescent; Anemia; Anemia, Iron-Deficiency; Anemia, Macrocytic; Child; Child, Preschool; Ferritins; Folic Acid; Folic Acid Deficiency; Hematology; Hemoglobins; Humans; Infant; Iron; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Humans; Liver Cirrhosis; Male; Middle Aged; Vitamin B 12

Current guidelines pertaining to diagnosing macrocytic anemia in association with vitamin B12 and folate deficiency recommend that vitamin B12, folate, homocysteine, and methylmalonic acid assays should be assessed concurrently due to their close relationship in metabolism. We aimed to investigate the completion of these assays in local clinics and hospitals without in-house clinical laboratories in Korea.. We retrospectively reviewed data from the laboratory information system between September 25, 2017, and June 30, 2019, to investigate usage rates of vitamin B12, folate, homocysteine, and methylmalonic acid assays in patients with macrocytic anemia.. During the study period, 14 894 Korean adults among 109 524 (13.6%) total hemoglobin-tested subjects underwent concurrent erythrocyte mean corpuscular volume (MCV) tests. Among these 14,894 adults, 265 (1.2%) from 94 local clinics or hospitals without in-house clinical laboratories in Korea had macrocytic anemia. Furthermore, among these 265 adults, only one woman underwent serum vitamin B12 and folate assay and one man underwent serum homocysteine testing during the study period. No patients among the 265 individuals with macrocytic anemia received erythrocyte folate or methylmalonic acid testing (with either serum, plasma, random urine, or 24-hour collected urine).. The results of this study provide basic information regarding utilization rates of assays in association with vitamin B12 and folate deficiency. Making more data available is expected to improve rates of testing in patients with macrocytic anemia in local clinics and hospitals without in-house clinical laboratories in Korea.

Topics: Adult; Anemia, Macrocytic; Blood Chemical Analysis; Erythrocyte Indices; Folic Acid; Folic Acid Deficiency; Hematologic Tests; Homocysteine; Humans; Methylmalonic Acid; Republic of Korea; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Anemia is a common finding and important cause of morbidity in patients with acute lymphoblastic leukemia (ALL) at diagnosis or during the course of its protracted treatment. We studied profile of anemia in ALL patients on maintenance therapy and evaluated specific micronutrients as cause of this anemia.. ALL patients who were on maintenance therapy and had grade ≥ 2 anemia were recruited for the study. Serum iron studies, folate, and vitamin B12 were done to identify micronutrient deficiency and to initiate supplementation with specific components if found to be deficient. Toxicities, improvement of anemia, micronutrient levels, and disease outcome were studied after 3 months.. From March 2015 to September 2016, 105 ALL patients were found to be on maintenance fulfilling the inclusion criteria. Overall, the proportion of anemia was 80%(N = 84). Majority had normocytic normochromic anemia (71%). Macrocytic anemia was seen in 18% and microcytic hypochromic in 9.5%. In patients with anemia of grade ≥ 2 (N = 84), 38 patients (45%) had biochemical deficiency of serum folate, and 7 (8%) had vitamin B12 deficiency. No biochemical evidence of iron deficiency was found. Supplementation of deficient micronutrients improved anemia: mean hemoglobin significantly increased from 8.06 ± 1.63 to 10.78 ± 1.53 (p < 0.001) at 3 months; and reduced treatment toxicities, mean number of febrile neutropenia episodes (p = 0.007), and treatment interruptions of > 2 weeks (p = 0.002) were lowered. Patients with anemia had significantly more relapses (N = 14,64%) compared to patients without anemia (N = 8,36%), (p = 0.040).. Timely identification and correction of micronutrient deficiencies causing anemia in ALL patients on maintenance can enhance treatment outcomes.

Topics: Adolescent; Adult; Anemia, Macrocytic; Child; Child, Preschool; Dietary Supplements; Female; Folic Acid; Hemoglobins; Humans; Infant; Iron Deficiencies; Male; Micronutrients; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Our previous study found 284 gastric parietal cell antibody (GPCA)-positive atrophic glossitis (AG) patients (so-called GPCA. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 117 high-titer GPCA. We found that 12.0%, 29.1%, 23.1%, 16.2%, 1.7%, and 23.1% of 117 high-titer GPCA. For GPCA

Topics: Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Tongue; Vitamin B 12; Vitamin B 12 Deficiency

Macrocytosis is defined as having the mean corpuscular volume (MCV) ≧ 100 fL. This study evaluated whether 41 atrophic glossitis (AG) patients with macrocytosis had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects or 1064 AG patients.. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 41 AG patients with macrocytosis, 1064 AG patients, and 532 healthy control subjects were measured and compared.. We found that 73.2%, 22.0%, 73.2%, 4.9%, 80.5%, and 56.1% of 41 AG patients with macrocytosis were diagnosed as having blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 41 AG patients with macrocytosis had significantly higher frequencies of blood hemoglobin and serum vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects or 1064 AG patients (all P-values < 0.001). In addition, 41 AG patients with macrocytosis also had significantly higher frequencies of serum iron and folic acid deficiencies than 532 healthy control subjects (both P-values < 0.001). Pernicious anemia was found in 22 AG patients with macrocytosis.. There are significantly higher frequencies of anemia and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with macrocytosis than in healthy control subjects. AG patients with macrocytosis also have significantly higher frequencies of blood hemoglobin and serum vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than AG patients.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Anemia, Macrocytic; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hematinics; Hematologic Diseases; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Tongue; Vitamin B 12; Young Adult

A vitamin B12 deficiency in infants is rare, but may sometimes be seen in breastfed babies of strict vegetarian mothers. Vitamin B12, also known as cobalamin, is only found in meat and other animal products. Most babies have a sufficient supply as long as the mother was not deficient herself. Symptoms and signs of vitamin B12 deficiency appear between the ages of 2 to 12 months and include vomiting, lethargy, failure to thrive, hypotonia, and arrest or regression of developmental skills. Urinary concentrations of methylmalonic acid and homocystine are characteristically elevated in vitamin B12 deficiency. Early treatment for a vitamin B12 deficiency in an infant involves immediate administration of vitamin B12 to the baby and the breastfeeding mother. The infant and mother will each receive an injection of vitamin B12 containing 1,000 mcg or more of the vitamin, and the mother will continue to receive injections every month to raise her own stores. After the initial injection, the baby will often receive future vitamin B12 through food sources. We present a case of vitamin B12 deficiency in a 9-month-old girl presented with psychomotor regression, hypotonia and lethargy. The child was exclusively breast-fed from birth by a mother who was on strict vegetarian diet and belong to a low socio-economic status. Laboratory data revealed bicytopenia with macrocytic anemia and methylmalonic acid in the urine, consistent with vitamin B12 deficient anemia. The Brain CT revealed a cerebral atrophy and delayed myelination. Vitamin B12 supply was effective on anaemia and psychomotor delay. This case figures out the importance of an early diagnosis in front of psychomoteur regression and hypotonia, given the risk of incomplete neurologic recovery due to vitamin B12 deficiency mainly in the setting of maternal nutritional deficiency.

Topics: Anemia, Macrocytic; Breast Feeding; Female; Humans; Infant; Mothers; Muscle Hypotonia; Psychomotor Disorders; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Approximately 13% of recurrent aphthous stomatitis (RAS) patients have serum anti-gastric parietal cell antibody (GPCA) positivity. This study assessed whether serum GPCA or RAS itself was a significant factor causing hematinic deficiencies and anemia statuses in GPCA-positive RAS (GPCA+/RAS) and all autoantibodies-negative RAS (Abs-/RAS) patients.. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 31 GPCA+/RAS patients, 240 Abs-/RAS patients, and 342 healthy control subjects.. GPCA+/RAS patients had significantly lower mean Hb and serum iron level (for women only) as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. Moreover, GPCA+/RAS patients had a significantly higher MCV and a significantly greater frequency of vitamin B12 deficiency than Abs-/RAS patients. Furthermore, Abs-/RAS patients did have significantly lower mean Hb, MCV, iron, and folic acid levels and significantly greater frequencies of Hb, iron, vitamin B12, and folic acid deficiencies than healthy control subjects. Of 31 GPCA+/RAS patients, 3 (9.7%) had PA, 6 (19.4%) had vitamin B12 deficiency, and 3 (9.7%) had macrocytosis. Moreover, normocytic anemia (54.0%) and iron deficiency anemia (26.4%) are the two more common types of anemia in our RAS patients.. We conclude that serum GPCA plays a significant role in causing vitamin B12 deficiency and high MCV in GPCA+/RAS patients. RAS itself does play a significant role in causing anemia and hematinic deficiencies in both GPCA+/RAS and Abs-/RAS patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Anemia, Iron-Deficiency; Anemia, Macrocytic; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Middle Aged; Parietal Cells, Gastric; Stomatitis, Aphthous; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

A 15-year-old boy on a vegetarian diet presented with severe macrocytic anaemia (haemoglobin, 5.1 g/dL; mean corpuscular volume, 116 fL) in addition to leucopenia and thrombocytopaenia (pancytopenia), icterus secondary to haemolysis and splenomegaly. Laboratory investigations revealed severe vitamin B12 (cobalamin) deficiency. Following cobalamin replacement therapy, the patient reported increased well-being, including appetite and weight gain, and his icterus resolved. In the follow-up laboratory examinations, leucocyte and platelet counts in addition to serum bilirubin and lactate dehydrogenase levels normalised. At the end of 2 months, laboratory findings, including haemoglobin level, were all within the normal range. We present this case as a reminder that severe vitamin B12 deficiency may present with findings mimicking acute leukaemia (pancytopenia and splenomegaly) and findings suggestive of pseudothrombotic microangiopathy.

Topics: Adolescent; Anemia, Macrocytic; Diagnosis, Differential; Hemolysis; Humans; Jaundice; Male; Pancytopenia; Splenomegaly; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Aged; Anemia, Macrocytic; Cross-Sectional Studies; Erythrocyte Indices; Erythrocytes; Erythrocytes, Abnormal; Female; Folic Acid; Hematologic Diseases; Humans; Male; Middle Aged; Risk Factors; Smoking; Vitamin B 12

Folic acid deficiency (FAD) may result in macrocytic anemia. This study assessed the hematinic deficiencies and anemia statuses in oral mucosal disease patients with FAD (defined as folic acid ≤ 6 ng/mL).. The blood hemoglobin (Hb), iron, vitamin B12, and folic acid concentrations, serum gastric parietal cell antibody level, and mean corpuscular volume (MCV) in 198 oral mucosal disease patients with FAD were measured. Based on World Health Organization (WHO) criteria, anemia or Hb deficiency was defined as having an Hb concentration of <13 g/dL for men and <12 g/dL for women. In this study, macrocytic anemia due to FAD was defined as having an MCV ≥100 fL and folic acid ≤6 ng/mL; pernicious anemia as having MCV ≥100 fL, vitamin B12 < 200 pg/mL, and serum gastric parietal cell antibody positivity; iron deficiency anemia as having MCV <80 fL and iron <60 μg/dL; and thalassemia trait as having MCV <74 fL, red blood cell (RBC) count > 5.0 × 10(12)/L, and Mentzer index (MCV/RBC) < 13.. We found that by WHO definitions, 73 (36.9%), 41 (20.7%), and 10 (5.1%) of our 198 FAD patients had concomitant Hb, iron, and vitamin B12 deficiencies, respectively. Of 73 anemic FAD patients, three had macrocytic anemia due to FAD, one had pernicious anemia, 14 had iron deficiency anemia, eight had thalassemia trait, and the resting 47 had normocytic anemia.. In addition to macrocytic anemia (2.0%), FAD patients may have concomitant normocytic (23.7%) or microcytic (11.1%) anemia.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Anemia, Macrocytic; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Middle Aged; Mouth Diseases; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Nutritional deficiency anaemia in vegans is common and usually due to lack of vitamin B12, as this vitamin is found almost exclusively in animal-based food products. In this case report we present a 39-year-old male vegan with severe macrocytic anaemia due to vitamin B12 deficiency as well as secondary hyperparathyroidism due to severe vitamin D deficiency. We want to emphasize the importance of a detailed nutritional history for patients with anaemia, and the need for vitamin B12 and vitamin D supplements for people who comply with a vegan diet.

Topics: Adult; Anemia, Macrocytic; Diet, Vegan; Dietary Supplements; Humans; Hyperparathyroidism, Secondary; Male; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Pernicious anaemia is an autoimmune disease caused by intrinsic factor antibody; it leads to vitamin B12 deficiency and is marked by ineffective erythropoiesis. Haematological features reveal macrocytosis, hyperchromasia and hypersegmented neutrophils. Schistocytes are typically seen in microangiopathy, such as in thrombotic thrombocytopaenic purpura (TTP)/haemolytic uraemic syndrome or disseminated intravascular haemolysis (DIC). We report a case of a patient with severe anaemia who presented to the emergency room. Peripheral smear revealed macrocytosis, hypersegmented neutrophils and marked schistocytosis. The patient also had high reticulocyte count with high serum lactate dehydrogenase, elevated D-dimer, low fibrinogen and low haptoglobin. Vitamin B12 level came back low and the presence of intrinsic factor antibody confirmed pernicious anaemia. ADAMTS13 level was noted to be mildly reduced, which raised the suspicion of the association of acquired TTP with pernicious anaemia. Acquired TTP is another autoimmune disorder and its association with pernicious anaemia needs further evaluation.

Topics: ADAM Proteins; ADAMTS13 Protein; Aged; Anemia, Macrocytic; Anemia, Pernicious; Autoantibodies; Autoimmune Diseases; Erythrocyte Count; Erythrocytes, Abnormal; Erythropoiesis; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Haptoglobins; Hemolytic-Uremic Syndrome; Humans; Intrinsic Factor; L-Lactate Dehydrogenase; Neutrophils; Purpura, Thrombotic Thrombocytopenic; Vitamin B 12

Anemia and macrocytosis are well-defined expected hematologic findings of vitamin B12 and folate deficiency; however, some previous studies did not show a significant association of subnormal B12 with anemia and macrocytosis.. We retrospectively analyzed 17 713 laboratory patient records to evaluate vitamin B12 and folate levels in relation to anemia and macrocytosis.. In an age- and sex-adjusted logistic regression model, low B12 status but not marginal B12 status was significantly associated with anemia [ORs respectively, 1.291 (95% CI, 1.182-1.410), 1.022 (95% CI, 0.943-1.108)] and macrocytosis [ORs, respectively, 3.853 (95% CI, 3.121-4.756), 1.031 (95% CI, 0.770-1.381)]. Also low folate status but not marginal folate status was significantly associated with anemia [adjusted ORs, respectively, 1.819 (95% CI, 1.372-2.411), 1.101 (95% CI, 0.931-1.301)] and macrocytosis [adjusted ORs, respectively, 2.945 (95% CI, 1.747-4.965), 1.228 (95% CI, 0.795-1.898)].. Our results show that increased anemia and macrocytosis are observed at values below commonly used B12 lower-reference thresholds. Determining a hematologic cutoff value may help physicians in clinical practice.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Humans; Logistic Models; Male; Middle Aged; Reference Values; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Whether folic acid fortification and supplementation at the population level have led to a higher prevalence of vitamin B-12 deficiency in the absence of anemia remains to be examined among a nationally representative sample of older U.S. adults. We assessed the prevalence of low vitamin B-12 status in the absence of anemia or macrocytosis before and after fortification among adults aged >50 y using cross-sectional data from the NHANES 1991-1994 (prefortification) and 2001-2006 (postfortification). We compared the prefortification and postfortification prevalence of multiple outcomes, including serum vitamin B-12 deficiency (<148 pmol/L) and marginal deficiency (148-258 pmol/L) with and without anemia (hemoglobin <130 g/L for men, <120 g/L for women) and with and without macrocytosis (mean cell volume >100 fL) using multinomial logistic regression, adjusting for age, sex, ethnicity, body mass index, C-reactive protein, and vitamin B-12 supplement use. Prefortification and postfortification serum vitamin B-12 deficiency without anemia [4.0 vs. 3.9%; adjusted prevalence ratio (aPR) (95% CI): 0.98 (0.67, 1.44)] or without macrocytosis [4.2 vs. 4.1%; aPR (95% CI): 0.96 (0.65, 1.43)] remained unchanged. Marginal deficiency without anemia [25.1 vs. 20.7%; aPR (95% CI): 0.82 (0.72, 0.95)] or without macrocytosis [25.9 vs. 21.3%; aPR (95% CI): 0.82 (0.72, 0.94)] were both significantly lower after fortification. After fortification, higher folic acid intake was associated with a lower prevalence of low serum B-12 status in the absence of anemia or macrocytosis. Results suggest that the prevalence of low serum B-12 status in the absence of anemia or macrocytosis among older U.S. adults did not increase after fortification. Thus, at the population level, we found no evidence to support concerns that folic acid adversely affected the clinical presentation of vitamin B-12 deficiency among older adults.

Topics: Aged; Anemia, Macrocytic; Cross-Sectional Studies; Diet; Dietary Supplements; Female; Folic Acid; Food, Fortified; Hemoglobins; Humans; Logistic Models; Male; Middle Aged; Nutrition Surveys; Prevalence; United States; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

In developed countries, vitamin B12 (cobalamin) deficiency usually occurs in children, exclusively breastfed ones whose mothers are vegetarian, causing low body stores of vitamin B12. The haematologic manifestation of vitamin B12 deficiency is pernicious anaemia. It is a megaloblastic anaemia with high mean corpuscular volume and typical morphological features, such as hyperlobulation of the nuclei of the granulocytes. In advanced cases, neutropaenia and thrombocytopaenia can occur, simulating aplastic anaemia or leukaemia. In addition to haematological symptoms, infants may experience weakness, fatigue, failure to thrive, and irritability. Other common findings include pallor, glossitis, vomiting, diarrhoea, and icterus. Neurological symptoms may affect the central nervous system and, in severe cases, rarely cause brain atrophy. Here, we report an interesting case, a 12-month old infant, who was admitted with neurological symptoms and diagnosed with vitamin B12 deficiency.

Topics: Anemia, Macrocytic; Atrophy; Breast Feeding; Cerebral Cortex; Diet, Vegetarian; Humans; Infant; Magnetic Resonance Imaging; Male; Mothers; Treatment Outcome; Turkey; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Adult; Anemia, Macrocytic; Female; Folic Acid; Humans; Students; Syncope; Vitamin B 12

A previously healthy 66-year-old women presented with onset of general weakness, shortness of breath and significant weight loss. Due to appearance of jaundice, biliary obstruction had been ruled out by a CAT scan previous to the patients presentation in our practice.. The laboratory tests already arranged by the patients general practitioner showed a pronounced pancytopenia with megaloblastic anemia and hyperbilirubinemia. The bone marrow aspiration revealed a hypercellular bone marrow with megaloblastic erythropoiesis. The diagnosis of pernicious anemia was confirmed by the low cobalamin (vitamin B12) serum level and the presence of atrophic gastritis.. Pernicious anemia was treated with intramuscular injection of Cyanocobalamin (1000 µg) which resulted in an immediate reticulocytosis and a widely normalized blood cell count and bilirubin level four weeks after initiation of treatment.. The differential diagnosis of megaloblastic anemia covers a wide spectrum of diseases with different etiology. This case report demonstrates an example of a pernicious anemia with atypical and foudroyant clinical course.

Topics: Aged; Anemia, Macrocytic; Autoimmune Diseases; Biopsy; Bone Marrow; Diagnosis, Differential; Erythrocyte Indices; Female; Gastritis, Atrophic; Gastroscopy; Humans; Infusions, Intravenous; Jaundice; Megaloblasts; Pancytopenia; Ultrasonography; Vitamin B 12

Unexplained macrocytic anemia was common in our hemodialysis (HD) unit. Vitamin B12 requirements may be higher in HD patients; therefore, patients may be deficient despite "normal" serum levels. We studied vitamin B12 status and the effect of parenteral vitamin B12 administration in macrocytic HD patients. A normocytic group was included for comparison.. Prospective cohort study of 62 HD patients (34 macrocytic, 28 normocytic) from November 2008 to March 2009. Patients were on stable doses of darbepoetin and iron replete. Vitamin B12 1,000 µg IV was given once weekly for 4 weeks and follow-up was 12 weeks. Methylmalonic acid (MMA) level was used as an indicator of vitamin B12 status. MCV and hemoglobin were also examined for an effect of B12 administration.. At baseline: all patients had serum B12 levels > 200 pmol/l; 97% had serum folate levels > 55 nmol/l; there was no difference in serum B12 levels between groups (504 vs. 571 pmol/l, p = 0.18); MMA was higher in the macrocytic group (0.56 vs. 0.48 µmol/l, p = 0.048) and hemoglobin (Hg) was lower (119 vs. 125 g/l, p = 0.03); median darbepoetin dose was equivalent (20 µg/week). Following IV vitamin B12, the macrocytic group had a greater and more sustained reduction in MMA (-0.064 vs. -0.0066 µmol/l/wk, p = 0.004). There was no improvement in hemoglobin (Hg), reticulocyte count or MCV in either group. Median darbepoetin dose was unchanged.. IV vitamin B12 led to a sustained decline in MMA levels in macrocytic patients, suggesting functional vitamin B12 deficiency at baseline. However, there were no significant changes in Hg or darbepoetin dose.

Topics: Aged; Aged, 80 and over; Anemia, Macrocytic; Biomarkers; Chi-Square Distribution; Erythrocyte Indices; Female; Hemoglobins; Humans; Infusions, Intravenous; Kidney Failure, Chronic; Male; Methylmalonic Acid; Middle Aged; Prospective Studies; Renal Dialysis; Statistics, Nonparametric; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Folate-deficiency anaemia occurs in about 4 per 100 000 people, although severe cases causing moderate pancytopenia are rarer. We present the case of a significant folate deficiency in a 50-year-old alcoholic with a background of mild liver impairment and recurrent nasal and rectal bleeding. Her blood tests showed profound macrocytic anaemia with haemoglobin 2.6 g/dl, leucopoenia with white cell count 3.2 × 10(9)/litre and thrombocytopenia with platelets 17 × 10(9)/litre. Serum folate was 0.8 ng/ml (normal 2.5-13.5 ng/ml) confirming severe deficiency. Despite these life-threatening results, the patient was stable, alert and was keen to avoid admission. Medical management of the anaemia included slow transfusion of red cells and one unit of platelets in view of haemorrhagic symptoms, two injections of vitamin B12 while awaiting assays and oral folic acid. A rapid improvement in the leucopoenia and thrombocytopenia resulted and no additional complications were encountered.

Topics: Anemia, Macrocytic; Combined Modality Therapy; Epistaxis; Erythrocyte Transfusion; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Humans; Leukopenia; Liver Diseases, Alcoholic; Middle Aged; Pancytopenia; Platelet Transfusion; Thrombocytopenia; Vitamin B 12

A diagnosis of myelodysplastic syndrome, refractory anemia subtype, was made in an elderly Indian woman on the basis of a refractory macrocytic anemia with normal vitamin B(12) and folate assays, normal thyroid function, essentially normal liver function and normal cytogenetic analysis. Disease evolution revealed that the diagnosis was erroneous.

Topics: Aged; Anemia, Macrocytic; Anemia, Pernicious; Anemia, Refractory; Diagnostic Errors; Diet, Vegetarian; Female; Humans; Myelodysplastic Syndromes; Vitamin B 12

Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical.. We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score < 34) in senior participants in the 1999-2002 US National Health and Nutrition Examination Survey.. The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration < 148 pmol/L or a serum methylmalonic acid concentration > 210 nmol/L-the maximum of the reference range for serum vitamin B-12-replete participants with normal creatinine.. After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% CI: 1.7, 4.2], macrocytosis (OR: 1.8; 95% CI: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% CI: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate > 59 nmol/L (80th percentile), as opposed to < or = 59 nmol/L, was associated with anemia (OR: 3.1; 95% CI: 1.5, 6.6) and cognitive impairment (OR: 2.6; 95% CI: 1.1, 6.1). In the normal vitamin B-12 group, ORs relating high versus normal serum folate to these outcomes were < 1.0 (P(interaction) < 0.05), but significantly < 1.0 only for cognitive impairment (0.4; 95% CI: 0.2, 0.9).. In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.

Topics: Aged; Aging; Anemia; Anemia, Macrocytic; Cognition Disorders; Confidence Intervals; Creatinine; Female; Folic Acid; Food, Fortified; Humans; Male; Nutrition Surveys; Nutritional Status; Odds Ratio; Vitamin B 12; Vitamin B 12 Deficiency

A 25-year-old woman was admitted because of severe anemia and exercise-induced tachypnea and dyspnea. She had no gastrointestinal symptoms and reported no allergies. The family history did not reveal any obvious or familial disease.. Whole blood analysis showed severe macrocytic anemia. The vitamin B12 level was reduced and biopsies revealed autoimmune gastritis and typical megaloblastic changes in the bone marrow. Gastroscopy showed marked mucosal atrophy as seen in celiac disease. Vitamin B12 was administered parenterally and she was put on a gluten-free diet.. The combination of autoimmune gastritis and celiac sprue is most likely a variant of the polyglandular autoimmune syndrome type 2. Early diagnosis, life-long gluten-free diet and vitamin B12 administration as well as appropriate aftercare prevent serious complications.

Topics: Adult; Anemia, Macrocytic; Autoimmune Diseases; Bone Marrow; Celiac Disease; Female; Gastritis; Glutens; Humans; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Large intakes of folic acid may delay the diagnosis of vitamin B-12 deficiency, which could lead to irreversible neuropathy.. The objective of this study was to determine whether the proportion of individuals with low serum vitamin B-12 without macrocytosis (undiagnosed vitamin B-12 deficiency) has increased in the post-folic acid fortification period.. Individuals aged >or=19 y with low serum vitamin B-12 (<258 pmol/L) and mean corpuscular volume (MCV) measured between 1995 and 2004 were identified from medical records. The proportion and odds ratios of individuals with low serum vitamin B-12 without macrocytosis by sex, race, and age according to prefortification (n = 86), perifortification (n = 138), and postfortification (n = 409) periods were determined.. MCV was significantly lower in the postfortification period (88.6 fL) than in the prefortification (94.4 fL; P < 0.001) and perifortification (90.6 fL; P = 0.007) periods. The proportion of subjects with low serum vitamin B-12 without macrocytosis was significantly higher in the postfortification (approximately 87%) and perifortification (approximately 85%) periods than in the prefortification period (approximately 70%; P < 0.001). In a sex-, race-, and age-adjusted analysis, the odds ratio for having low serum vitamin B-12 without macrocytosis was 3.0 (95% CI: 1.7, 5.2) in the postfortification period relative to the prefortification period.. Subjects with low serum vitamin B-12 were likely to be without macrocytosis in the postfortification period. MCV should not be used as a marker for vitamin B-12 insufficiency. It is possible that folic acid fortification may have led to a correction of macrocytosis associated with vitamin B-12 insufficiency.

Topics: Age Factors; Aged; Anemia, Macrocytic; Confidence Intervals; Diagnosis, Differential; Erythrocyte Indices; Female; Folic Acid; Food, Fortified; Humans; Male; Middle Aged; Nutritional Status; Odds Ratio; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Aged; Anemia, Macrocytic; Comorbidity; Epilepsy; Humans; Male; Polyneuropathies; Vitamin B 12; Vitamin B Deficiency

Divalproex (DVP) is increasingly prescribed to children and adolescents in psychiatric practices. Among the hematologic adverse effects of DVP, decreased platelet count is well described in the medical literature. However, to date, few studies describe the occurrence of macrocytosis as an adverse effect of divalproex. We report two cases of pediatric patients who developed macrocytosis and decreasing platelet counts secondary to DVP treatment. Because macrocytosis remained an asymptomatic nonprogressive condition for our patients, we support the recommendation for closer surveillance of the patients' complete blood counts for development of anemia in addition to thrombocytopenia.

Topics: Anemia, Macrocytic; Anticonvulsants; Bipolar Disorder; Child; Dose-Response Relationship, Drug; Erythrocyte Indices; Female; Folic Acid; Follow-Up Studies; Humans; Platelet Count; Thrombocytopenia; Valproic Acid; Vitamin B 12

Helicobacter pylori has been identified as a possible cause of vitamin B12 deficiency in the general population. We assessed any potential relationship between low cyanocobalamin serum levels and Helicobacter pylori status in hemodialysis patients and subsequently correlated these results with the existence of anemia (a common complication in hemodialysis patients), and macrocytosis.. In 29 chronic hemodialysis patients, active H. pylori infection was diagnosed using two different methods regardless of digestive symptoms: by searching for bacterial antigens in stools and by the detection of urea breakdown through breath testing. If these results were non-coincident, gastroscopy was performed and antral biopsies obtained. Patients were subsequently divided into group A (H. pylori-positive, n = 8, 28%) and group B (H. pylori-negative, n = 21, 72%). The corresponding initial values of erythrocytic folic acid, vitamin B12 and homocysteine prior to the first hemodialysis session of each patient were retrospectively collected.. Vitamin B12 levels (normal 200- 900 pg/ml) were significantly lower in group A compared to group B (225.4 +/- 111.9 vs. 707.9 +/- 258.3 pg/ml, p < 0.011). In group A, 5 patients (63%) had vitamin B12 deficiency (154 +/- 24.6 pg/ml). Baseline hematocrits, erythrocyte folic acid and serum homocysteine levels were not different between the groups, but mean corpuscular volumes were significantly higher in group A compared to group B (109.7 +/-14.1 vs. 91.8 +/- 8.8 fl, p = 0.002).. H. pylori-positive chronic hemodialysis patients may present with lower vitamin B12 blood levels and macrocytosis. H. pylori infection should be suspected in this population when low or low-normal vitamin B12 levels or macrocytosis exist.

Topics: Anemia, Macrocytic; Female; Folic Acid; Helicobacter Infections; Helicobacter pylori; Homocysteine; Humans; Kidney Failure, Chronic; Male; Middle Aged; Prevalence; Renal Dialysis; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

There is concern that exposure of patients to folic acid may prevent the development of the macrocytosis of cobalamin deficiency and thus delay the detection of the neurological complications. We examined the relationship between low cobalamin levels and mean cell volume (MCV) at different serum folate concentrations in 63,472 blood samples tested in a community pathology laboratory over 2 years. We found no evidence that high serum folate levels masked the macrocytosis of cobalamin deficiency in this population with similar increases in MCV regardless of whether the serum folate was low, normal or high. Macrocytosis appears to retain its value as a marker of cobalamin deficiency in people with serum folate concentrations above the population average.

Topics: Anemia, Macrocytic; Erythrocyte Indices; Folic Acid; Humans; Statistical Distributions; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Animals; Biomarkers; Dietary Supplements; Disease Models, Animal; Folic Acid; Folic Acid Deficiency; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; beta-Thalassemia; Erythrocyte Indices; Female; Folic Acid Deficiency; Gastritis; Hemoglobins; Humans; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Evidence-Based Medicine; Folic Acid; Humans; Mass Screening; Practice Guidelines as Topic; Predictive Value of Tests; Reproducibility of Results; Research Design; Retrospective Studies; Vitamin B 12

Macrocytosis is most commonly associated with vitamin B(12) and folic acid deficiency, followed by alcoholism, liver disease, and other pathologic conditions. We studied the red cell and vitamin status in 423 consecutive patients with various liver diseases, including 31 with acute viral hepatitis (AVH), 105 with chronic hepatitis (CH), and 134 with alcoholic liver disease (ALD), who consisted of 84 with non-cirrhotic alcoholic liver disease (NCALD) and 50 with alcoholic liver cirrhosis (ALC), 60 with non-alcoholic liver cirrhosis (NALC), and 93 with hepatocellular carcinoma (HCC). The mean corpuscular volume (MCV) and red cell distribution width (RDW) were significantly higher in patients with ALD and NALC, and among them macrocytosis occurred more frequently in patients with ALC. Macrocytic anemia was mostly found in cirrhotic patients, in which the Child-Pugh score was closely related to the development of macrocytic anemia. In ALD, the MCV was significantly correlated with the estimated alcohol consumption and inversely correlated with the serum folic acid level, which, however, was often maintained within the normal range in patients with macrocytic ALC. After abstinence from alcohol, the MCV and RDW were reduced significantly and were associated with an increasing serum folic acid level. This suggests that macrocytic anemia was a common feature of alcoholic and non-alcoholic liver cirrhosis and that alcohol abuse and folic acid deficiency play a secondary role in macrocytosis.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Erythrocyte Aging; Erythrocyte Indices; Female; Folic Acid; Hepatitis, Chronic; Hepatitis, Viral, Human; Humans; Liver Diseases, Alcoholic; Male; Middle Aged; Vitamin B 12

Vitamin B12 deficiency is a very rare disease of infants and young children in Europe. Authors report a case of a 9.5-month-old infant who was exclusively breast-fed by his vegan mother and developed serious vitamin B12 deficiency in form of neurological regression, repetitive vomiting, drowsiness, dysphagia, obstipation, and tremor. A few days after intramuscular vitamin substitution his abnormal signs improved dramatically, hematological restitution was reached in six weeks. Authors describe the hematological and neurological signs, the diagnostic and differential-diagnostic pitfalls, therapy, prognosis, and prevention of this condition. Beside reviewing the literature they emphasize the importance of early recognition and intervention and the need of an appropriate doctor-parent cooperation in this disease.

Topics: Adult; Anemia, Macrocytic; Breast Feeding; Diagnosis, Differential; Diet, Vegetarian; Female; Humans; Infant; Injections, Intramuscular; Male; Neuromuscular Diseases; Prognosis; Vitamin B 12; Vitamin B 12 Deficiency

Elevation of mean cell volume (MCV) is a common clinical problem, but the etiologic spectrum and optimal diagnostic evaluation of macrocytosis are not well defined.. We studied 300 consecutive hospitalized adult patients with MCV values > or = 100 fL. Assessment included complete blood counts, morphologic review, liver function tests, and levels of serum cobalamin (Cbl), methylmalonic acid, and total homocysteine.. The most common cause of macrocytosis was drug therapy, followed by alcohol, liver disease, and reticulocytosis. Megaloblastic hematopoiesis accounted for less than 10% of cases. MCV values > 120 fL were usually caused by Cbl deficiency. Anisocytosis, macro-ovalocytosis, and teardrop erythrocytes were most prominent in megaloblastic hematopoiesis. Elevated levels of serum methylmalonic acid and total homocysteine were useful in the diagnosis of Cbl deficiency.. Drugs and alcohol are the most common causes of macrocytosis in hospitalized patients in a New York City teaching hospital. We have formulated tentative guidelines for the evaluation of high MCV values in this setting.

Topics: Adult; Aged; Alcohol Drinking; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Diseases; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; L-Lactate Dehydrogenase; Leukocyte Count; Liver Diseases; Liver Diseases, Alcoholic; Male; Methylmalonic Acid; Middle Aged; Platelet Count; Predictive Value of Tests; Prospective Studies; Reticulocyte Count; Sensitivity and Specificity; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Aged; Anemia, Macrocytic; Cyanides; Drug Hypersensitivity; Female; Humans; Hydroxocobalamin; Infusions, Parenteral; Injections, Intramuscular; Vitamin B 12; Vitamin B 12 Deficiency

If all the elements of the complete blood cell count are considered in clinical context, they can provide an invaluable guide to the possible causes of a patient's anemia and the tests needed for definitive diagnosis. Unnecessary tests not only add to the expense of treatment but may result in delayed diagnosis and inappropriate treatment in some cases.

Topics: Aged; Algorithms; Anemia, Macrocytic; Blood Cell Count; Blood Transfusion; Diagnosis, Differential; Female; Ferrous Compounds; Humans; Hypothyroidism; Pancytopenia; Thyroid Function Tests; Vitamin B 12; Vitamin B 12 Deficiency

To determine the diagnostic value of megaloblastic marrow in patients with possible vitamin B12 and/or folate deficiency and to look for criteria that could be used in diagnosis of vitamin B12 deficiency.. Prospective study.. Kenyatta National Hospital and M P Shah Hospital, Nairobi.. Patients of all age groups and both sexes presenting with clinical and blood picture of macrocytic anaemia.. Response to vitamin B12 injections. Vitamin B12 deficiency diagnosed by the following methods: Vitamin B12 serum level assays alone, bone marrow examination alone and both vitamin B12 assays and bone marrow examination. Response was measured clinically and by increase in haemoglobin level after three weeks of treatment.. Three hundred and forty-three patients were evaluated; 156 (45.5%) were males, and 187 (54.5%) females. Age range was 13-80 years and a mean of 37.7 years. Initial investigations were as follows: 21.9% had vitamin B12 assays only, 59.2% bone marrow examination only and 19.9% both vitamin B12 assayed and bone marrow evaluated. Haemoglobin increase after a total of 6,000 mcg of vitamin B12 was between 2.6-4.6 g/dl in three weeks. Reticulocytes measured on day ten ranged between 12% and 17%. Uniform improvement in all patients was observed for white blood cells (WBC) and platelet counts. Other significant results and observations included clinical improvement in the signs and symptoms of anaemia after the 6,000 mcg injection of vitamin B12 given over three weeks. Serum folic acid level was determined in 21% of cases and in all these it was normal.. The important practical points were response to vitamin B12 in all cases and the importance of re-assessing patients after a total of 6,000 mcg of vitamin B12. Folic acid deficiency was not detected. Patients in these two institutions with megaloblastic anaemia had vitamin B12 deficiency. It is proposed that a model consisting of oval macrocytosis on blood film and megablastic bone marrow be treated with vitamin B12 injections in settings where vitamin B12 serum level assays are not easily available.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Examination; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Hospitals, Urban; Humans; Kenya; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Contraindications; Erythropoiesis; Humans; Male; Megaloblasts; Multiple Myeloma; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Anti-Bacterial Agents; Breast Feeding; Developmental Disabilities; Diet, Vegetarian; Female; Humans; Infant; Male; Mother-Child Relations; Pneumonia; Syndrome; Treatment Outcome; Tremor; Vitamin B 12

Many patients suffer from vitamin B12 deficiency and are thus exposed to irreversible sequelae if diagnosis occurs at a late stage. This prospective study undertaken by eight practitioners over a period of 12 months concerns early diagnosis. Blood vitamin B12 levels were measured in 152 patients presenting macrocytosis detected by systematic MCV analysis at the time of a blood test, a neuropathy or a recent cognitive, affective and behavioural problem, and were found to be lowered (< or = 175 pmol/l) in 54 patients of whom 43 had undergone vitamin B12 test treatment for 6 months. Haematological, neurological and psychiatric evaluation was carried out before and after treatment, and a diagnosis of deficiency was recorded in 24 patients based on unequivocal response to therapy. Improvement was greatest haematologically in 12 patients, neurologically in 6 patients and psychiatrically in 6 other patients, with 4 patients showing a combination of all modes. These 24 patients (mean age 69 years) suffered from numerous pathologies which were liable to complicate diagnosis in some of them: neurological (46%), psychiatric (37%), chronic alcoholism (33%), folic acid deficiency (29%), and diabetes (17%). The only diagnostic element used as a criterion of deficiency was an extremely low level of vitamin B12 (< or = 75 pmol/l). Marked macrocytosis or a combination of haematological and neuropsychiatric signs are strong indicators, but only improvement under treatment allowed a diagnosis to be made in the majority of patients. Macrocytosis was, however, not present in 6 of the 12 neuropsychiatric patients. The study thus identified a high proportion of patients with vitamin B12 deficiency who additionally presented, in equal proportions, both haematological and neuropsychiatric symptoms. Neither the clinical examination nor the vitamin B12 level in general permit early diagnosis based on a high probability index and long-term follow-up. Simpler methods for early diagnosis are therefore needed.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Anemia, Macrocytic; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Patient Care Team; Vitamin B 12; Vitamin B 12 Deficiency

Over a 2-year period, we examined 48 patients with P-cobalamin levels in the difficult "grey zone" at the lower reference limit detected by a competitive protein binding assay using intrinsic factor as binder. In 21 of 30 patients (70%) with low P-cobalamins we could not establish the diagnosis of metabolic cobalamin deficiency, but 1 of 18 patients (6%) with low-normal P-cobalamin values was confirmed metabolically cobalamin-deficient. Half of these 30 patients with low P-cobalamins had neuropsychiatric disorders, but only one-third of the latter patients had metabolic cobalamin deficiency. Ten of the remaining 15 patients (67%) were characterized as non-deficient. In patients with low-normal P-cobalamin level, we found neuropsychiatric disorders in 5 of the 18 (28%), but none of these had metabolic cobalamin deficiency. We conclude that P-cobalamins below the reference interval combined with typical neuropsychiatric symptoms or findings are not diagnostic of cobalamin deficiency and that further analyses are necessary.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Anemia, Macrocytic; Female; Humans; Malabsorption Syndromes; Male; Mental Disorders; Middle Aged; Nervous System Diseases; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

To establish the ranges of full blood count (FBC), vitamin B12 and folate levels and to determine the prevalence of occult haematological abnormalities in older Zimbabweans.. Community based cross sectional survey.. 278 randomly selected healthy Zimbabweans aged > 65 years. INTERVENTIONS/STUDY FACTORS: Haemoglobin level, MCV, folate, B12 alcohol consumption.. The median Hb was males 14.0 (range 8 to 18.3), females 13.1 g/dl (7.9 to 18.1). 23% were anaemic (Hb < 13 g/dl in males, < 12 g/dl in females), 3% with microcytic and 20% with macrocytic indices. Overall 13% had low vitamin B12 and 30% had low folate levels. Folate levels were significantly lower in urban subjects and B12 levels were significantly lower in rural subjects. Fifty four subjects (21%) had an MCV > 100 fl. In this group, low folate levels were found in 22, low B12 levels in nine, excessive alcohol in eight and two subjects had elevated TSH. The MCV was higher in urban subjects.. This study has revealed a large amount of occult haematological abnormality and interesting differences between rural and urban subjects. It focuses attention on low levels of folate, which should be preventable by simple nutritional education, as an extensive problem in the community.

Topics: Aged; Aged, 80 and over; Alcohol Drinking; Anemia; Anemia, Macrocytic; Blood Cell Count; Cross-Sectional Studies; Female; Folic Acid; Health Surveys; Humans; Male; Middle Aged; Prevalence; Residence Characteristics; Vitamin B 12; Zimbabwe

To estimate the potential benefits and risks of food folic acid fortification for an elderly population. Benefits are expected through the improvement of folate and homocysteine status, but there is also a risk of masking or precipitating clinical manifestations related to vitamin B12 deficiency with increasing exposure to folic acid.. Cross-sectional analysis, with projected change at various levels of folic acid fortification.. Participants in the Framingham Heart Study original cohort.. A total of 747 subjects aged 67 to 96 years who both completed usable food frequency questionnaires and had blood concentrations of B vitamins and homocysteine measured.. Projected blood folate and homocysteine concentrations and combined high folate intake and low plasma vitamin B12 concentration.. Percentages of this elderly population with folate intake below 400 microg/d are projected to drop from 66% at baseline to 49% with 140 microg of folate per 100 g of cereal-grain product, to 32% with 280 microg, to 26% with 350 microg, and to 11% with 700 microg. Percentages with elevated homocysteine concentrations (>14 micromol/L) are projected to drop from 26% at baseline to 21% with 140 microg of folate per 100 g, to 17% with 280 microg, to 16% with 350 microg, and to 12% with 700 microg. Without fortification, the prevalence of combined high folate intake (>1000 microg/d) and low plasma vitamin B12 concentration (<185 pmol/L [<250 pg/mL]) was 0.1%. This is projected to increase to 0.4% with folate fortification levels of 140 to 350 microg/100 g and to 3.4% with 700 microg.. The evidence suggests that, at the level of 140 microg/100 g of cereal-grain product mandated by the Food and Drug Administration, the benefits of folate fortification, through projected decreases in homocysteine level and heart disease risk, greatly outweigh the expected risks. However, quantification of the actual risks associated with vitamin B12 deficiency remains elusive. Before higher levels of folic acid fortification are implemented, further research is needed to better understand the clinical course of various forms of vitamin B12 deficiency, to measure the potential effect of high folate intake on this course, and to identify cost-effective approaches to the identification and treatment of all forms of vitamin B12 deficiency.

Topics: Aged; Aged, 80 and over; Anemia, Macrocytic; Cross-Sectional Studies; Female; Folic Acid; Food, Fortified; Homocysteine; Humans; Male; Regression Analysis; Risk; Vitamin B 12; Vitamin B 12 Deficiency

We have identified a 52-year-old woman and her 27-year-old daughter with macrocytosis, normal haemoglobin and mean corpuscular haemoglobin concentration. Macrocytosis could be demonstrated from the age of 40 and 25 respectively. All blood tests were normal including vitamin B12 and folic acid. Bone marrow investigation showed rare macroblasts without other abnormalities. Endoscopy of the upper gastrointestinal tract and ultrasonography of the abdomen were normal. Thus, persistent macrocytosis was present without evidence of diseases that might account for it. In these subjects, macrocytosis is likely to be related to the presence of a genetic defect.

Topics: Adult; Anemia, Macrocytic; Female; Folic Acid; Humans; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Folic Acid; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Alcoholism; Anemia, Macrocytic; Drug Therapy, Combination; Female; Folic Acid; Hematinics; Humans; Ileal Diseases; Malabsorption Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

The oral manifestations of glossitis, stomatitis and mucosal ulceration in vitamin B12 deficiency have long been recognised. These oral changes may occur in the absence of symptomatic anaemia or of macrocytosis. The aim of this paper is to describe a retrospective study of the wide range of oral signs and symptoms reported by 14 patients found to have a previously undiagnosed vitamin B12 deficiency. None of the patients described in this study had generalised symptoms sufficiently advanced to arouse suspicions of vitamin B12 deficiency. The essential criteria for the diagnosis of pernicious anaemia are also discussed.

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Burning Mouth Syndrome; Cheilitis; Female; Glossalgia; Glossitis; Humans; Male; Mouth Diseases; Mouth Mucosa; Retrospective Studies; Stomatitis; Stomatitis, Denture; Ulcer; Vitamin B 12; Vitamin B 12 Deficiency

Two cases of severe myeloneuropathy and macrocytic anemia associated with a low serum level of vitamin B12 after prolonged exposure to nitrous oxide are reported. In both cases, the neurological manifestations worsened initially despite B12 supplementation, although in one case the use of methionine seemed to arrest the progression of the disease and accelerate recovery. This offers further support for the biochemical hypothesis of methionine synthetase inhibition by nitrous oxide and reproduces in man previously reported animal studies with methionine. Methionine may be an important first-line therapy in the initial treatment of neuropathy and myeloneuropathy induced by nitrous oxide, and has a hypothetical role in the treatment of subacute combined degeneration of the cord.

Topics: Adult; Anemia, Macrocytic; Female; Humans; Male; Methionine; Nervous System Diseases; Neuromuscular Diseases; Nitrous Oxide; Sensation Disorders; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Camelids, New World; Copper; Iron; Liver; Male; Manganese; Reference Values; Superoxide Dismutase; Trace Elements; Vitamin B 12; Zinc

The mean corpuscular volume of erythrocytes in persons with Down syndrome is larger than normal in the absence of anemia. The mean mean corpuscular volume among our 61 subjects with trisomy 21 was 99.08 fl (range = 90 to 107). Red blood cell survival half-time was substantially shorter than normal in many of these patients. These findings suggest that erythrocytes have a younger mean age in persons with Down syndrome. The increased red blood cell turnover in this population may indicate an accelerated aging process of red blood cells.

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Down Syndrome; Erythrocyte Aging; Erythrocyte Count; Erythrocyte Indices; Female; Folic Acid; Hematocrit; Hemoglobinometry; Humans; Iron; Male; Middle Aged; Reticulocytes; Vitamin B 12

Topics: Adult; Age Factors; Anemia, Macrocytic; Anemia, Refractory; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Methylation of cytosine residues in DNA samples, collected before and serially after cobalamin treatment from patients with cobalamin deficiency, was studied using restriction endonucleases Hpa II and Msp I and an epsilon globin gene probe. There was no evidence of hypomethylation in any of the samples. It was concluded that although hypomethylation of metabolites such as choline occurs, that of DNA is preserved in megaloblastic anaemia.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Blotting, Southern; Deoxyribonuclease HpaII; Deoxyribonucleases, Type II Site-Specific; DNA; DNA Probes; Humans; Methylation; Vitamin B 12

One hundred and thirty-seven cases of stomach cancer given fluoropyrimidines (UFT: 66 cases, Tegafur: 58 cases, 5-FU: 13 cases) after gastrectomy as the adjuvant chemotherapy were examined as to appearance of macrocytic anemia. The mean corpuscular volume (MCV) gradually elevated in all cases but seven after administration. Macrocytic anemia, defined by the elevation over 20% compared with both pre-operative and pre-administrative values of MCV, was developed 30.3% in UFT group, 8.6% in tegafur group and 30.8% in 5-FU group. The incidence was statistically higher in UFT group (p less than 0.01) and 5-FU group (p less than 0.05) than in tegafur group. The cause was attributed to fluoropyrimidine administration because the serum folate and vitamin B12 levels remained normal and the value of MCV normalized after cessation of administration. Each total dose to induce macrocytic anemia was potentially about 70g in UFT. 100g in tegafur and 30 g in 5-FU. In conclusion, periodical hematological examination is necessary for the patients given fluoropyrimidine preparations.

Topics: Anemia, Macrocytic; Antineoplastic Combined Chemotherapy Protocols; Erythrocyte Indices; Female; Fluorouracil; Folic Acid; Humans; Male; Retrospective Studies; Stomach Neoplasms; Tegafur; Uracil; Vitamin B 12

This case report concerns a patient with a vitamin B12 deficiency and a normal Schilling test, who had macrocytosis of many years' duration and finally polyneuropathy. All known causes of a vitamin B12 deficiency were excluded. When the Schilling test was performed with egg consumption, excretion of vitamin B12 was clearly diminished. It appears highly likely that this vitamin B12 deficiency developed as a result of malabsorption of protein-bound vitamin B12.

Topics: Adult; Anemia, Macrocytic; Dietary Proteins; Female; Humans; Malabsorption Syndromes; Peripheral Nervous System Diseases; Vitamin B 12; Vitamin B 12 Deficiency

A case of 78-year old man with megaloblastic anemia occurring 20 years after partial gastrectomy is reported. Since about 2 years earlier he had an episode of convulsion, and he had been on anti-convulsants (diphenylhydantion, phenobarbital) until admission. Physical examination revealed a pale lean man with polyneuropathy and mental impairment. Laboratory findings revealed WBC 3100/microliters, RBC 187 X 10(4)/microliters, HB 7.9 g/dl, MCV 124.4 microns3, MCH 42.7 micrograms, platelet counts 15.7 X 10(4)/microliters, serum vitamin B12 (VB12) 380 pg/ml, and serum folic acid 5.1 ng/ml. Serum autoantibodies to intrinsic factor (IF) and parietal cells were positive. Bone marrow examination revealed erythroid hyperplasia and megaloblastic changes. Schilling test revealed impaired absorption of VB12 with or without IF, but X-ray study of the small bowels was unremarkable. Treatment with intramuscular cyanocobalamin resulted in a rapid clinical improvement. A repeat Schilling test after 4 months of therapy showed a normal VB12 absorption in the presence of IF. These findings suggest that VB12 malabsorption of the 1st Schilling test was due to intestinal dysfunction caused by the VB12 deficiency state itself, and the improvement of VB12 absorption with IF after therapy suggests a pathogenesis similar to pernicious anemia in this patient.

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Autoantibodies; Gastrectomy; Humans; Intrinsic Factor; Male; Postoperative Complications; Schilling Test; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Cells; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Immerslund-Grasbeck syndrome is an uncommon disease, characterized by megaloblastic anaemia and persistent proteinuria. A Libyan boy with the characteristic findings is presented. He received intramuscular vitamin B12 injections and there followed a remarkable clinical and haematological improvement.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Child; Humans; Libya; Male; Proteinuria; Syndrome; Vitamin B 12

Between January 15 and April 30, 1988, one thousand assays of serum vitamin B12 and folates were performed, and the reasons why they were requested as well as their clinical usefulness are discussed. In 50 cases these assays were requested for a suspected myeloproliferative syndrome; in some of the patients with polycythaemia vera an excess of B12 was observed without hyperleukocytosis, an argument for keeping the B12 assay as an element of initial evaluation. In numerous cases the assays were performed for aetiological evaluation of a macrocytosis of suspected alcoholic origin in most patients; more than 50 per cent of the patient had folate deficiency and only a few had low B12 values. Folate levels were frequently low and B12 levels generally normal in patients with gastrointestinal disease, but many of them had been supplemented with folate and/or B12 prior to the assay. More than 20 per cent of the 1,000 assays were performed in patients aged 80 years or more, and more than 50 per cent of them had a low folate level; this has no consequences for individual subjects, but it may be of epidemiological or sociological interest. It must be mentioned that too many blood samples (more than 40 per cent) were sent to the laboratory without adequate information and after supplementation in 20 per cent of the cases. Very few patients with very low B12 levels were subjected to Schilling's test, so that the clinical usefulness of this assay, as currently utilized, is questionable in a large number of cases.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anemia, Macrocytic; Child; Child, Preschool; Digestive System Diseases; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant, Newborn; Middle Aged; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Megaloblastic anaemia is very rare in the first weeks of life and it is related to impaired metabolism of folic acid or vitamin B12. One of this disorders is the congenital transcobalamin II deficiency. The case of a three month old infant, with vomiting, diarrhoea and severe anaemia is presented. Both parents and the child had very low or undetectable levels of serum TC II, respectively. Using i.m. hydroxycobalamin at high doses, the clinical and laboratory responses have been satisfactory.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Infant; Leucovorin; Male; Transcobalamins; Vitamin B 12

The laboratory findings of 20 patients with untreated megaloblastic anemia due to vitamin B12 deficiency were analysed. The material consists of 13 patients with pernicious anemia, 6 with postgastrectomy B12 deficiency and one with malabsorption syndrome. Hematological data (RBC, Hgb, Ht, WBC, Plt) were correlated with each other and serum LDH levels. Megaloblastic changes of bone marrow were apparent in cases of which Hgb values were below 9 g/dl, although its change were not clear in cases with mild anemia (above 9 g/dl). However, giant metamyelocytic changes of bone marrow were seen even in cases with mild anemia. Serum B12 levels in 6 out of 19 cases (31.6%) measured by clinical laboratory center were within normal range. In contrast, its level in all cases measured by radiodilution assay using R-protein or intrinsic factor were lower than normal values. Serum B12 levels measured by the latter method were correlated with various hematological data and also related with hematological severity, although its level measured by clinical laboratory did not have any correlation with hematological data. Schilling test seemed to be unreliable, because sample volume which was suggested by kit manual was too small (2 ml) to catch enough radioactivity for accurate measurement. Serum methylmalonic acid levels measured by gas capillary mass spectrophotometry were higher than normal values in all cases and were well correlated with hematological data.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Humans; Male; Malonates; Methylmalonic Acid; Middle Aged; Predictive Value of Tests; Radioisotope Dilution Technique; Schilling Test; Spectrophotometry; Vitamin B 12; Vitamin B 12 Deficiency

We examined causes and hematological consequences of low serum cobalamin (vitamin B12) concentration in two representative population samples of 70-year-old (N = 293) and 75-year-old subjects (N = 486). Subjects with values below 130 pmol/liter (4.8% and 5.6%, respectively) were investigated with Schilling test, upper gastrointestinal endoscopy, determination of serum gastrin and group I pepsinogens, and bone marrow examination. Gastrointestinal abnormalities of etiologic significance were found in 26 of the 32 examined subjects: atrophy of the gastric body mucosa (N = 16, with pernicious anemia in six), partial gastrectomy (N = 6), and intestinal malabsorption (N = 4). Megaloblastic hematopoiesis was found in 10 individuals, four of whom had macrocytic anemia. Our results indicate that low serum cobalamin concentration in the elderly is usually a consequence of disease rather than of high age per se and that gastric mucosal atrophy is a major etiologic factor.

Topics: Aged; Aging; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Bone Marrow Examination; Digestive System; Endoscopy; Female; Gastrins; Gastrointestinal Diseases; Humans; Male; Pepsinogens; Schilling Test; Vitamin B 12

A 40-year-old man who was resected ascending colon and terminal ileum (10 cm) in Aug. 1978, with the diagnosis of Crohn's disease, was admitted to our hospital with general fatigue, paresthesia and tremor in May. 1984. A peripheral blood examination on admission revealed Hb 10.1 g/dl, RBC 234 X 10(4)/mm3, MCV 131.4 fl, MCH 43.2 pg. A bone marrow specimen showed marked erythroid hyperplasia (W/E 1.44) with megaloblastic change. While serum folate level was normal, serum vitamin B12 value was low and Schilling test showed vitamin B12 malabsorption. Roentgenologic and endoscopic examinations revealed diffuse cobblestone appearances in small intestine (from anastomosis part to duodenal bulb). These examinations suggested vitamin B12 malabsorption with diffuse Crohn's disease caused megaloblastic anemia. The patient had been treated with vitamin B12 1,000 micrograms/day injection and, in Sep. 1984, he recovered from megaloblastic anemia (Hb 13.4 g/dl, RBC 440 X 10(4)/mm3, MCV 90.7 fl, MCH 30.4 pg).

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Crohn Disease; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Male; Middle Aged; Polycythemia Vera; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Fibroblasts; Homocystinuria; Humans; Infant, Newborn; Male; Malonates; Methylmalonic Acid; Mutation; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Bone Marrow Examination; Female; Humans; Mouth Diseases; Schilling Test; Vitamin B 12; Vulvar Diseases

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Humans; Nitrous Oxide; Vitamin B 12

Among factors causing the hepatopath's relative erythrocyte macrocytosis, the influence of alcohol and liver function damage was compared. Hepatopathic macrocytosis is different from Biermer's macrocytosis and evidently involves different pathogenetic mechanisms. It is significant that a deficit in vit. B12 does not occur and a modest deficit in folates only rarely. There is much evidence of an alteration in lipidemia and particularly in apo-protein content. It is concluded that the two factors considered have different mechanisms but produce the same results.

Topics: Anemia, Macrocytic; Female; Humans; Lipid Metabolism; Liver Diseases; Liver Diseases, Alcoholic; Male; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Humans; Male; Pedigree; Vitamin B 12

A number of patients with megaloblastic anemia and homocystinuria associated with low levels of methylcobalamin synthesis in cultured cells have been recognized. Methionine biosynthesis by intact cells, as determined by incorporation of label from 5-[14C]methyl-tetrahydrofolate into acid-precipitable material, was deficient in cultured skin fibroblasts that were derived from all of these patients. In one group of patients, activity of the methylcobalamin-dependent enzyme, methionine synthase, in cell extracts was within the normal range when the enzyme was assayed under standard conditions. In a second group of patients, methionine synthase activity was decreased under the same assay conditions. Genetic complementation analysis demonstrated the existence of two complementation classes that corresponded to these two groups of patients. The designation cblE has previously been proposed for normal methionine synthase activity. We propose the designation cblG for the mutation in those patients with methylcobalamin deficiency and decreased synthase activity. The results of these studies suggest that the products of at least two loci are required for cobalamin-dependent methionine biosynthesis in mammalian cells.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Anemia, Macrocytic; Anemia, Megaloblastic; Cells, Cultured; Fibroblasts; Genetic Complementation Test; Homocystinuria; Humans; Methionine; Mutation; Vitamin B 12; Vitamin B 12 Deficiency

When patients are examined for possible cobalamin deficiency, great stress is often placed on the presence or absence of macrocytosis and anemia and on how low the serum cobalamin level is. The present study, however, shows that only 45 (64%) of 70 consecutively diagnosed patients with pernicious anemia, the most common cause of cobalamin deficiency, had very low cobalamin levels (less than 74 pmol/L [or less than 100 ng/L]). Anemia was absent in 13 (19%) of the patients, and macrocytosis was absent in 23 (33%) of the patients; such absence was particularly common when cobalamin levels were only slightly or moderately low (74 to 184 pmol/L). Coexisting iron deficiency was responsible for the absence of macrocytosis in nine patients. Of the ten patients with neither anemia nor macrocytosis, neurological disturbance was prominent in six, including four whose only noticeable abnormality was cerebral. These observations indicate that macrocytosis and anemia, two classic features of pernicious anemia, may be overstressed in our diagnostic approach. All subnormal serum cobalamin results are best viewed as pathological until proved otherwise. Emphasis on only very low cobalamin levels risks delaying the diagnosis of pernicious anemia in a substantial proportion of cases, particularly in those without anemia or macrocytosis.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Erythrocyte Indices; Erythrocytes, Abnormal; Female; Hemoglobins; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

During a 5 year period, 28 adult patients with megaloblastic anaemia (MA) were treated in University Hospital. 71% of the patients were Indians. Symptoms of anaemia was the main presenting complaint in 18 (64%) of patients while in 2 patients peripheral neuropathy was the main problem. Pancytopenia was a common finding (present in 18 (64%) patients) while 6 (21%) patients had severe thrombocytopenia (less than 20 x 10(9)/L). The peripheral blood morphology provided important diagnostic clues i.e. macrocytes and/or hypersegmented neutrophils seen in most patients. Concurrent iron deficiency 'dampened' the megaloblastic picture. Though most patients suffered from MA of nutritional origin, 3 patients were diagnosed to have pernicious anaemia and 2 patients had myelodysplastic syndrome. Important practice points were detection of concurrent infection and hypokalemia which necessitated appropriate treatment. The controversy of blood transfusion in treatment of MA and the importance of reassessing patients after treatment were highlighted.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Bone Marrow; Folic Acid; Humans; Pancytopenia; Vitamin B 12

The results of an Interregional quality assurance scheme for tests in the diagnosis of megaloblastic anaemia were reviewed to assess the methods used. Serum folate assays showed great variation between methods, partly due to limitations in assessment by external quality assurance. Red cell folate assays yielded widely different results and much imprecision due both to the differences in preparation of the haemolysate and to the problems inherent in radioassay of a mixture of folate compounds. Intrinsic factor antibody tests showed appreciable variation in sensitivity. There was considerable inconsistency in the detection of polymorph nuclear hypersegmentation.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Antibodies; Erythrocytes; Folic Acid; Humans; Intrinsic Factor; Laboratories; Methods; Neutrophils; Quality Control; Vitamin B 12

The figures obtained in simultaneous radioimmunological assays of serum folate and vitamin B12 concentrations and erythrocyte folate concentration in 74 patients are presented. All these patients had a regular daily intake of over 80 g ethyl alcohol and presented an increase in mean blood cell volume. Most of the patients were males hospitalised with liver disease and/or anaemia. All were given bone narrow needle aspirations and liver biopsies. 46% of the patients presented a reduction in erythrocyte folates but vitamin B12 deficiency was rarely encountered. Megaloblastic transformation of the bone narrow was present in 56% of the alcoholics with reduced erythrocyte folates and in 10% of those with normal folate concentration. No correlation was found between serum and erythrocyte folate concentration and degree of liver damage. Serum vitamin B12 levels were higher in patients with cirrhosis. Inadequate diet was frequently found in the alcoholics with reduced folate concentrations. Due to variations in patient selection it is difficult to compare these data with those of other series but they do seem to confirm the hypothesis that the macrocytosis in most "healthy" alcoholics reflects a direct toxic action of the alcohol on erythropoiesis. In contrast folate deficiency is found among "derelict" chronic alcoholics in whom the vitamin deficiency has often not yet produced megaloblastosis of the bone marrow.

Topics: Adult; Aged; Aged, 80 and over; Alcoholism; Anemia, Macrocytic; Anemia, Megaloblastic; Erythrocytes; Female; Folic Acid; Humans; Male; Middle Aged; Vitamin B 12

Topics: Adolescent; Anemia, Macrocytic; Follow-Up Studies; Humans; Intestinal Absorption; Intrinsic Factor; Lymphangiectasis, Intestinal; Malabsorption Syndromes; Male; Protein-Losing Enteropathies; Proteinuria; Vitamin B 12; Vitamin B 12 Deficiency

A case of megaloblastic anaemia probably caused by malabsorption is analysed. Blood potassium levels were monitored before and during treatment with vitamin B12. It is concluded that low potassium levels in chronically hypoxic patients may be dangerous and that blood potassium should be monitored constantly during the treatment of this type of anaemia.

Topics: Aged; Aged, 80 and over; Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Hypokalemia; Male; Vitamin B 12

A male infant with methyl-B12 deficiency (cblE) presented at age 6 weeks with lethargy, staring spells, and vomiting. He later became hypotonic and unresponsive to stimuli and required intubation and ventilation. He had homocystinuria and hypomethioninemia with megaloblastic anemia but normal serum folate and vitamin B12 concentrations. No methylmalonic aciduria was detected. Fibroblasts, cultured from the patient, were unable to grow in medium in which homocysteine replaced methionine and incorporated abnormally small amounts of [14C]-methyl-tetrahydrofolate but normal amounts of [14C]-propionate into protein. Methyl-B12 content of fibroblasts was low, while the adenosyl-B12 content was normal. Methionine synthase activity was decreased when the assay was performed under both optimal and suboptimal reducing conditions, suggesting heterogeneity in the cblE disease. The patient responded dramatically to hydroxocobalamin treatment. Homocystinuria disappeared after 10 days of therapy, and methionine was normalized after 3 weeks. Psychometric testing at age 15 months showed a developmental age of 9 months.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Cells, Cultured; Fibroblasts; Homocysteine; Homocystinuria; Humans; Infant; Male; Methionine; Vitamin B 12; Vitamin B 12 Deficiency

We present findings on an infant with neonatal megaloblastic anemia, homocystinuria, and neurologic dysfunction that included developmental delay and tonic seizures. There was no methylmalonic aciduria. Cyanocobalamin therapy was accompanied by complete hematologic and neurologic recovery, diminished homocystine excretion, and subsequently normal neurologic development. Cultured fibroblasts and lymphoblasts showed a reduced methionine synthase activity and a growth requirement for methionine. Cobalamin incorporation by the patient's lymphoblasts was normal, but the proportion of cellular methylcobalamin in the patient's lymphoblasts and fibroblasts were markedly reduced and that of adenosylcobalamin normal. The reduced methionine synthase activity was independent of assay reducing (thiol) conditions, but normal levels of activity accompanied culture of the patient's lymphoblasts in medium with markedly increased cobalamin concentration. The characteristics of the reduced methionine synthase of our patient differ significantly from that of the previously described infant with cobalamin E disease and suggest that genetic heterogeneity may characterize this mutation.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Anemia, Macrocytic; Anemia, Megaloblastic; Cell Division; Fibroblasts; Homocystinuria; Humans; Infant; Lymphocytes; Male; Methyltransferases; Vitamin B 12

We have identified a patient with methylmalonic aciduria and homocystinuria due to a defect in cobalamin metabolism of the cb1C type mutant. At the time of admission at eight months of age the patient was malnourished, hypotonic and had macrocytic anemia. Neonatal screening for hypermethioninemia associated with homocystinuria had been normal. Serum vitamin B12 was markedly increased and folate concentration was above normal, as were urinary homocystine and methylmalonic acid. The patient had abnormal brain stem auditory and visual evoked potentials. Fibroblast activity of N5-methyltetrahydrofolate: homocysteine methyltransferase was reduced to approximately 10% of concurrent controls. A course of therapy with hydroxocobalamin resulted in a 90% reduction in excretion of methylmalonic acid and normalization of the evoked potentials. These studies support the efficacy of hydroxocobalamin therapy in this disease, suggest that methylmalonic acid may be the most appropriate metabolite to monitor for therapeutic response, and in importance of electrophysiologic studies in character in objectively monitoring the response to treatment metabolic disease.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Amino Acid Metabolism, Inborn Errors; Anemia, Macrocytic; Brain Damage, Chronic; Follow-Up Studies; Hemoglobinometry; Homocystinuria; Humans; Infant; Male; Malonates; Methylmalonic Acid; Methylmalonyl-CoA Mutase; Vitamin B 12

Topics: Adolescent; Anemia, Macrocytic; Anemia, Megaloblastic; Diphyllobothriasis; Feeding Behavior; Humans; Intestinal Diseases, Parasitic; Male; Niclosamide; Vitamin B 12

Five cases of severe megaloblastic anaemia in Gambians are described. Three of the patients were found to have pernicious anaemia. The difficulties in diagnosis and the various features of pernicious anaemia in Negroes are discussed. A brief review of the literature is included.

Topics: Adolescent; Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Erythrocyte Indices; Female; Folic Acid; Gambia; Hemoglobins; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Megaloblastic anaemia in infancy is uncommon in western countries. We describe a case of an exclusively breast-fed monozygous twin with severe vitamin B12 deficiency with haematologic and neurologic abnormalities. Treatment with vitamin B12 resulted in a rapid haematological and clinical improvement.

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Breast Feeding; Diseases in Twins; Female; Humans; Infant; Iron Deficiencies; Male; Twins; Twins, Monozygotic; Vitamin B 12; Vitamin B 12 Deficiency

Megaloblastic anaemia due to bacterial overgrowth of the small intestine is due to vitamin B12 malabsorption. This report describes a patient with bacterial overgrowth of the small intestine who had megaloblastic anaemia and malabsorption of vitamin B12, but persistently normal levels of serum vitamin B12 and normal serum and red cell folate levels. However, there was evidence of vitamin B12 deficiency as shown by an abnormal deoxyuridine suppression test and by the response to treatment with physiological doses of vitamin B12. A relative increase in biologically inactive vitamin B12 analogues may be the explanation for the normal vitamin B12 level in this patient.

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Humans; Intestine, Small; Vitamin B 12; Vitamin B 12 Deficiency

138 Indian patients with megaloblastic haemopoiesis were studied. All were lifelong vegetarians. The diagnosis was nutritional cobalamin deficiency in 95 and pernicious anaemia in 20; only 4 patients had folate deficiency. A third had intestinal malabsorption, 20 had features of osteomalacia, and 87 were iron deficient. Tuberculosis was diagnosed in 17. Cobalamin deficiency may have contributed to these complications via intestinal malabsorption and impaired bacterial killing of phagocytosed bacilli by cobalamin-deficient macrophages. The frequency of pernicious anaemia was the same in Indian subjects as in Caucasians.

Topics: Absorption; Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Antibodies; Child; Diet, Vegetarian; England; Erythrocytes; Female; Folic Acid; Humans; India; Intestinal Mucosa; Intestines; Iron Deficiencies; Male; Middle Aged; Religion; Vitamin B 12; Vitamin B 12 Deficiency

24 normocyclic East African short-horned goats were made vitamin B12-deficient through feeding cobalt-deficient Rhodes grass (Chloris gayana) hay. The deficiency was confirmed by controls of the blood level, by the occurrence of anaemia, by increased cortisol levels, and by hypertrophy of the fasciculata and reticulata zones in the adrenal cortex. The oestrogen level increased initially, and then decreased markedly from the 3rd cycle on, and reached levels below those of the control. Ovulations finally ceased. It is suggested that ovarian dysfunctions during vitamin B12 deficiency are caused by changes in the endocrine profile.

Topics: Adrenal Cortex Hormones; Anemia, Macrocytic; Animal Feed; Animals; Body Weight; Cobalt; Estrogens; Estrus; Female; Goats; Kenya; Organ Size; Ovary; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

The first case of megaloblastic anemia due to selective malabsorption of vitamin B(12) and vitamin B(12)-intrinsic factor is described in an otherwise normal female adult, in whom pernicious anemia had previously been diagnosed.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Female; Humans; Ileum; Intrinsic Factor; Vitamin B 12

Two elderly patients with vitamin B12 deficiency were found to have low immunoglobulin levels. These returned to normal on treatment with vitamin B12.

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Humans; Immunoglobulins; Male; Vitamin B 12

The incidence of macrocytic anemia has been investigated in 32 patients on maintenance hemodialysis (mean age 46 years, mean duration of dialysis treatment 27.5 months), in 18 patients with combined hemodialysis (HD) and hemofiltration (HF) treatment (mean age 42 years, mean duration of combined HD and HF treatment 6.3 months) and in 32 patients after renal transplantation (mean age 41 years, mean observation period since successful renal transplantation 55.2 months). Also investigated were serum levels of vitamin B12 (radioassay kit 57Co) and folic acid (radioassay kit 125J). Macrocytosis (MCV greater than 96 fl) was observed in 38% of the patients on maintenance hemodialysis, in 44% of the patients with combined HD and HF treatment, and in 47% of the renal transplant recipients. In the chronically dialysed patients, in contrast to the patients with combined HD and HF treatment, the mean serum folic acid level was significantly lower (p less than 0.005) than that of healthy controls. Serum levels of vitamin B12 were within the normal range in all patients. There were no significant differences in serum levels of folic acid and vitamin B12 between the patients with MCV greater than 96 fl and MCV less than or equal to 96 fl. Nor was there a correlation between the serum levels of folic acid or vitamin B12 and mean corpuscular volume. These results suggest that folic acid deficiency is of minor importance in the complex pathogenesis of anemia in hemodialysed patients.

Topics: Adult; Aged; Anemia, Macrocytic; Blood; Blood Cell Count; Erythrocyte Indices; Female; Folic Acid; Hematocrit; Hemoglobins; Humans; Kidney Transplantation; Male; Middle Aged; Renal Dialysis; Ultrafiltration; Vitamin B 12

Cultured fibroblasts from a recently described patient with homocystinuria and megaloblastic anemia of infancy without methylmalonic aciduria were previously shown to have normal cobalamin uptake and a specific decrease in the proportion of intracellular methylcobalamin. As in control cells but unlike in those from patients with combined homocystinuria and methylmalonic aciduria (cobalamin C and cobalamin D), accumulated 57Co-labeled cobalamin was bound in appropriate amounts and proportion to intracellular binders which are known to be the two vitamin B12-dependent enzymes, methionine synthetase and methylmalonyl-CoA mutase. Despite the association of a normal quantity of intracellular cobalamin with methionine synthetase, the proportion of intracellular cobalamin which was methyl-B12 was below normal and in the range observed in cobalamin C and D cells. This methyl-B12 was decreased by exposure of fibroblasts in culture to nitrous oxide as was observed with control cells. Exposure of control fibroblasts during culture, but not of fibroblasts from this patient, to nitrous oxide significantly reduced the holoenzyme activity of methionine synthetase assayed in cell extracts. In addition, although methionine synthetase activity in cell extracts of control and cells from the patient were similar in the presence of standard assay concentrations of thiols, at low thiol concentrations, methionine synthetase activity in extracts of cells from the patient was much lower than in control extracts. Mixing of control patient extracts corrected this decreased activity in excess of that explained by addition of the individual activities added. The defect of this patient appears to be in a reducing system required for methionine synthesis.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Anemia, Macrocytic; Anemia, Megaloblastic; Cells, Cultured; Fibroblasts; Homocystinuria; Humans; Methionine; Nitrous Oxide; Vitamin B 12

Topics: Adolescent; Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Male; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Diagnosis, Differential; FIGLU Test; Folic Acid; Humans; Vitamin B 12

We describe an inborn error of vitamin B12 metabolism in an infant who had severe developmental delay, megaloblastic anemia, and homocystinuria. There was no evidence of methylmalonic aciduria or deficiency of folate or vitamin B12. Treatment with hydroxocobalamin, but not with cyanocobalamin and folic acid, resulted in rapid clinical and biochemical improvement. Cultured fibroblasts showed an absolute growth requirement for methionine, defective incorporation of radioactivity from [14C]5-methyltetrahydrofolate into protein, and normal incorporation of radioactivity from [14C]propionate, thus assigning the intracellular defect to methionine synthesis. The proportion of intracellular methylcobalamin in the fibroblasts was decreased, but that of 5'-deoxyadenosylcobalamin was normal. Methionine synthetase activity in cell extracts was normal, as was cobalamin incorporation into cultured cells. This defect differs from those described previously in being limited to methylcobalamin accumulation and defective use of 5-methyltetrahydrofolate by intact cells with normal activity of methylmalonyl CoA mutase.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Amino Acid Metabolism, Inborn Errors; Anemia, Macrocytic; Anemia, Megaloblastic; Cobamides; Fibroblasts; Homocystinuria; Humans; Hydroxocobalamin; Infant, Newborn; Male; Methionine; Propionates; Tetrahydrofolates; Vitamin B 12

A follow-up study has been performed on 14 patients, now aged 6-46 years, with Imerslund-Gräsbeck anemia (congenital, hereditary selective malasorption of vitamin B12). On intramuscular vitamin B12 therapy, the patients are clinically and hematologically normal. Those who had constant proteinuria in childhood continue to excrete protein in the urine. Our patients excrete an average of 750 mg of protein per 24 hours (range 13-1460 mg). The proteinuria is predominantly of glomerular origin, but some is also of tubular origin. Renal biopsies of the two oldest patients were normal on light microscopy. Electron microscopy revealed moderate signs of chronic glomerulopathy of mesangioproliferative type in both patients. The renal lesions do not seem to be progressive.

Topics: Adolescent; Adult; Anemia, Macrocytic; Child; Chronic Disease; Female; Follow-Up Studies; Humans; Kidney; Kidney Function Tests; Male; Middle Aged; Prognosis; Proteinuria; Recurrence; Syndrome; Vitamin B 12

The etiologic explanation of an anemia is important for the most effective therapy of that anemia. This may also define an underlying disease process. The etiology of the anemia can be achieved by appropriate use of the history, physical examination, and laboratory data. This information may be used to clarify the anemia, define a diagnosis, and direct appropriate therapy.

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sickle Cell; Blood Cell Count; Cytodiagnosis; Erythrocyte Indices; Erythrocyte Transfusion; Female; Ferrous Compounds; Hematologic Tests; Humans; Male; Physical Examination; Reticulocytes; Thalassemia; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Autoantibodies; Deoxyuridine; Erythrocyte Indices; Folic Acid; Humans; Intrinsic Factor; Reagent Kits, Diagnostic; Schilling Test; Vitamin B 12

Topics: Aged; Anemia; Anemia, Macrocytic; Blood Cell Count; Blood Transfusion; Chlorambucil; Erythrocyte Indices; Hematocrit; Hematologic Diseases; Hemoglobins; Humans; Leukemia, Lymphoid; Middle Aged; Multiple Myeloma; Platelet Count; Polycythemia Vera; Reticulocytes; Thalassemia; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Diabetes Mellitus; Female; Humans; Malabsorption Syndromes; Metformin; Vitamin B 12; Vitamin B 12 Deficiency

One or more episodes of recurrent megaloblastic anemia occurred in 36 (10.8 percent) of 333 patients with pernicious anemia following interruption of therapy. Treatment had most commonly been discontinued by patients because they felt well, or by physicians due to error. Thirty-five episodes of recurrent cobalamin deficiency were analyzed in detail. In the 24 patients in whom the exact date of cessation of therapy was recorded, the mean interval before relapse was diagnosed was 64.5 months (range 21 to 123 months). Recurrence manifested as macrocytosis in the absence of anemia occurred earlier (mean, 49.2 months) than that associated with anemia (73.1 months). A weak correlation was apparent between the amount of previous cyanocobalamin treatment and time to relapse. One third of relapses were unrecognized and left untreated for more than two years, while usually slow hematologic progression occurred. Recurrences of cobalamin deficiency in individual patients exhibited mimetic features. Further study is necessary to establish the optimal dosage and frequency of maintenance therapy in pernicious anemia.

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Fatigue; Female; Glossitis; Hematocrit; Humans; Male; Medication Errors; Middle Aged; Recurrence; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Infant; Vitamin B 12; Vitamin B 12 Deficiency

Typical features on the blood smear suggest the diagnosis in some types of anemia, such as the common microcytic anemias, megaloblastic anemias, and certain hemolytic anemias. Some laboratory tests used in anemia, particularly measurement of serum vitamin B12 and folate levels, may present problems in interpretation, which must be recognized if diagnostic errors are to be avoided. Normocytic anemias that are nonhemolytic, have no obvious cause, and are characterized by marked red cell changes on the blood smear should prompt careful investigation for malignancy or marrow fibrosis. Anemias are often multifactorial, and the diagnosis must be reevaluated after the apparent contributing causes have been treated. A number of "danger signs" in a patient with anemia point to the need for hematologic consultation.

Topics: Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow Examination; Chronic Disease; Diagnosis, Differential; Folic Acid; Humans; Thalassemia; Vitamin B 12

A patient with pernicious anemia who developed a mild macrocytic anemia after many years of monthly vitamin B(12) therapy is presented. There was no response to the addition of folic acid and multivitamins. Evaluation for causes of elevated mean corpuscular volume and consideration of associated autoimmune disorders led to the diagnosis of primary hypothyroidism. Treatment with levothyroxine led to correction of the hematologic abnormalities over a four-month period. The anemia of hypothyroidism may present with macrocytic indices and this diagnosis should be suspected when this finding is noted.

Topics: Aged; Anemia, Macrocytic; Female; Folic Acid; Humans; Hypothyroidism; Vitamin B 12

The incidence and pathogenesis of acute megaloblastic bone-marrow change and of abnormalities in DNA synthesis, as assessed with the deoxyuridine(dU) suppression test, have been investigated in a prospective study of 70 seriously ill patients admitted to an intensive-care unit. On admission megaloblastic bone-marrow change was present in 22 patients, 18 of whom had been anaesthetised with nitrous oxide for 2-6 h during surgical procedures before admission. 16 of these 18 patients died, compared with 7 of 22 patients in whom haemopoiesis remained normoblastic despite receiving equivalent amounts of nitrous oxide. An abnormal dU-suppression test developed only in patients who had received nitrous oxide; on admission an abnormal dU-suppression test was found in 39 of the 42 patients tested who had been exposed to the anaesthetic. The abnormality produced in the dU-suppression test by nitrous oxide in patients admitted to the intensive-care unit was more severe and recovery was slower than the abnormality seen in patients undergoing cardiac-bypass surgery. During the recovery period from the effects of nitrous oxide the pattern of correction of the dU-suppression test changed from that of vitamin-B12 deficiency to folate deficiency.

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anesthesia; Bone Marrow; Child; Deoxyuridine; DNA; Female; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Humans; Intensive Care Units; Male; Middle Aged; Nitrous Oxide; Vitamin B 12

The role of vitamin B12 in the folate dependent biosynthesis of thymidine nucleotides is controversial. In an attempt to clarify this, three methods have been used to assess the relative efficacy of vitamin B12 (hydroxocobalamin) and various folate analogues in titrated concentrations at correcting 'de novo' thymidylate synthesis by megaloblastic human marrow cells: (1) The deoxyuridine (dU) suppression test which analyses the reduction in (3H)-thymidine labeling of DNA by unlabeled dU. Marrow cells were also labeled with (6-3H)-dU with assessment of (2) its incorporation into DNA and (3) the accumulation of (6-3H)-deoxyuridine monophosphate (3H-dUMP). The three methods gave similar results. In both, N6-formyl tetrahydrofolate (formyl-FH4) was the most effective agent at correcting thymidylate synthesis in megaloblastic anemia due to vitamin B12 or folate deficiency. Vitamin B12 corrected the lesion in vitamin B12 deficiency but not in folate deficiency. Tetrahydrofolate (FH4) and folic acid were effective in deficiency of vitamin B12 or folate, although in both deficiencies they were less effective than formyl-FH4. Methyl-FH4 was effective in folate deficiency but not in vitamin B12 deficiency. These results confirm the failure of methyl-FH4 utilisation in vitamin B12 deficiency. They suggest that if vitamin B12 is needed in the formylation of FH4, this is a minor role in provision of the correct coenzyme for thymidylate synthesis compared with its major role of provision of FH4 from methyl-FH4.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Leucovorin; Tetrahydrofolates; Thymine Nucleotides; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Aging; Alcoholism; Anemia; Anemia, Aplastic; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Animals; Blood Cell Count; Drug-Related Side Effects and Adverse Reactions; Female; Ferrous Compounds; Folic Acid; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Humans; Male; Mice; Reference Values; Vitamin B 12

The activities of 5-methyltetrahydrofolate (5-CH3THF) related enzymes and DNA polymerase alpha were determined in bone marrow cells obtained from patients with vitamin B12 deficient megaloblastic anemia and compared with those from healthy volunteers and patients with hemolytic anemia. 5-CH3THF homocysteine methyltransferase activity was significantly lower than that in the control subjects. 5,10-methylenetetrahydrofolate reductase activity was only slightly elevated to that in the control subjects. DNA polymerase alpha activity was significantly higher than that in the control. High deoxyuridine suppression test values in vitamin B12 deficient bone marrow cells were improved by tetrahydrofolate, but not by 5-CH3THF. These data indicate that, even though the reverse reaction catalyzed by 5,10-methylenetetrahydrofolate reductase may be operative in vitamin B12 deficiency, it is not sufficient to correct the disturbance in folate metabolism in vitamin B12 deficiency. Increased DNA polymerase alpha activity may be due to compensation for disarranged DNA synthesis.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; 5,10-Methylenetetrahydrofolate Reductase (FADH2); Adult; Aged; Alcohol Oxidoreductases; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Bone Marrow Cells; Deoxyuridine; DNA Polymerase II; DNA-Directed DNA Polymerase; Female; Folic Acid; Humans; Hydroxocobalamin; Leucovorin; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Tetrahydrofolates; Thymidine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Anemia, Megaloblastic; Child; Humans; Malabsorption Syndromes; Metabolism, Inborn Errors; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin E Deficiency

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Diagnosis, Differential; Humans; Male; Megaloblasts; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid; Hematopoietic Stem Cells; Humans; Liver Cirrhosis; Male; Thymidine; Vitamin B 12

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Erythropoiesis; Female; Folic Acid; Humans; Male; Middle Aged; Peritoneal Dialysis; Renal Dialysis; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Leukemia, Myeloid, Acute; Male; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Biological Assay; Diagnostic Errors; Humans; Radioisotope Dilution Technique; Vitamin B 12

A patient with sickle cell trait and pernicious anemia in relapse may appear to have sickle thalassemia because HbA2 levels can be elevated and the peripheral blood smear may contain target cells, teardrop cells, and eliptocytes. A normal hemoglobin alpha:beta chain ratio, a megaloblastic bone marrow, and correction of the abnormal hematologic morphology after administration of vitamin B12 will establish the correct diagnosis.

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Diagnosis, Differential; Female; Humans; Sickle Cell Trait; Thalassemia; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Child, Preschool; Female; Humans; Infant; Malabsorption Syndromes; Male; Proteinuria; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Humans; L-Lactate Dehydrogenase; Vitamin B 12

A young Australian woman developed a severe nutritional megaloblastic anaemia due to poor intake of vitamin B12 and, possibly, of folic acid. Simple dietary advice resulted in an adequate intake of vitamin B12 and folic acid, and in maintenance of normal serum levels of both vitamins.

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alcoholism; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Folic Acid; Humans; Liver; Male; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Child; Child, Preschool; Female; Humans; Infant; Malabsorption Syndromes; Proteinuria; Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Aminosalicylic Acid; Anemia, Macrocytic; Anemia, Megaloblastic; Anticonvulsants; Antineoplastic Agents; Colchicine; Humans; Hydroxocobalamin; Intestinal Absorption; Neomycin; Stomach Neoplasms; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Diabetes Mellitus; Female; Humans; Intestinal Absorption; Metformin; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Erythrocytes; Folic Acid; Humans; Vitamin B 12

The numerical behaviour of the leucocytes, thrombocytes and reticulocytes of 12 patients with megaloblastic anaemia before and after additional transfusion as well as after following parenteral therapy with vitamin B12 was investigated. Transfusions alone had no influence on the numbers of leukocytes thrombocytes and reticulocytes. After 4--5 days vitamin B12 led to a very inhibited crisis of reticulocytes in 9 of the 12 patients, in the others an increase did not take place. Thrombocytes and leukocytes appeared partly in form of a crisis in all patients after 6 to 9 days with normalisation of the values, latest after 14 days. The very reduced or lacking crisis of reticulocytes after treatment with vitamin B12 due to previous additional transfusion was discussed.

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Transfusion; Erythrocyte Count; Humans; Middle Aged; Reticulocytes; Vitamin B 12

A retrospective study was undertaken to audit physician's management of patients with a low serum level of vitamin B12 who were admitted to a university-affiliated teaching hospital during 1 year. Among the 34 patients 13 were proved to have pernicious anemia or vitamin B12 malabsorption, but for 12 of them there were unnecessary delays (several days or weeks) before initiation of investigation and therapy. An additional six patients, who had low serum levels of vitamin B12 and macrocytosis, most likely had true vitamin B12 deficiency, but proper investigation was not done and they did not receive any vitamin B12 or folic acid therapy. In another nine cases unexplained low serum levels of vitamin B12 were not properly investigated, and the patients either did not receive any vitamin B12 therapy or received it without proper documentation of a deficiency. Suggestions for facilitating early detection, investigation and treatment of megaloblastic anemia or vitamin B12 deficiency are given.

Topics: Aged; Anemia, Macrocytic; Anemia, Pernicious; Erythrocyte Volume; Folic Acid; Humans; Middle Aged; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Erythrocyte Count; Erythrocyte Volume; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Reticulocytes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Animals; Haplorhini; History, 20th Century; Liver Extracts; London; Macaca mulatta; Riboflavin; Vitamin B 12

Topics: Age Factors; Anemia, Macrocytic; Diagnosis, Differential; Female; Humans; Infant; Syndrome; Vitamin B 12

We studied the rate of disappearance of neutrophil hypersegmentation in 23 patients with megaloblastic anemia during therapy with vitamin B12 and folic acid. In 14 patients with uncomplicated megaloblastic anemia, the neutrophil lobe average began to fall towards normal 11.4 +/- 0.3 (SEM) days after treatment was begun and became normal by 13.9 +/- 0.6 days. In nine patients with associated inflammatory disorders, the lobe average returned to normal more rapidly. In six initially neutropenic patients, a five-fold increase in total granulocyte count occurred by the eighth day and a seven-fold increment in the total number of circulating hypersegmented neutrophils. Granulocyte folate concentrations in five folate-deficient patients rose to normal levels within 4 to 7 days of starting therapy. Hypersegmentation thus persists for many days after correction of neutropenia and restoration of normal granulocyte folate levels have occurred. We conclude that cobalamin and folate are needed at two different steps in granulopoiesis.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Blood Cell Count; Folic Acid; Granulocytes; Humans; Neutrophils; Prospective Studies; Reticulocytes; Vitamin B 12

Renal biopsy material obtained from a 6 year old girl suffering from an Imerslund-Najman-Gräsbeck-syndrome was examined by light- and electron-microscopy. Clinically the patient presented the characteristic intrinsic factor independent vitamin B12 malabsorption with severe megaloblastic anemia and a benign nephropathy with non-selective proteinuria. Electron microscopic examination of the prenal glomeruli showed no obvious alterations of the Electron microscopic examination of the renal glomeruli showed no obvious alterations of the capillary basement membranes but revealed a considerable diffuse dilatation of the rough endoplasmic reticulum in the podocytes with accumulation of a finely fibrillar material within the widened cisternae. This finding is interpreted as an indication that the synthesis and/or secretory activities of the podocytes, as far as the basement membrane is concerned, and thus the basement membranes themselves, may be altered with the consequence of an increased permeability of the filtration barrier. Because proteinurie contrary to anemia did not respond to parenteral vitamin B12 therapy and therefore is obviously not vitamin B12 dependent, it is assumed that both vitamin B12 malabsorption and glomerulopathy in this hereditary disease are established by a pleiotropic gene or two closely associated genes.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Child; Female; Humans; Kidney Glomerulus; Malabsorption Syndromes; Microscopy, Electron; Proteinuria; Syndrome; Vitamin B 12

Despite the clinical use of the 'deoxyuridine suppression test' to document vitamin B12 or folate deficiency its biochemical basis is unclear and currently disputed. Because of this the metabolism of deoxyuridine in marrow cells has been examined. In normoblastic marrow cells the ratio of radio-labelled deoxyuridine to thymidine incorporation into DNA approximates one and preincubation of cells with unlabelled deoxyuridine results in progressive reduction of uptake of both radio-labelled deoxynucleosides. In the same cells methotrexate significantly reduces the DNA incorporation of deoxyuridine but not that of thymidine. In megaloblastic marrow the ratio of radio-labelled deoxyuridine to thymidine uptake is less than one and the reduced deoxyuridine uptake is not significantly altered by either cyanocobalamin or folic acid. With megaloblastic samples the reduction by deoxyuridine of radio-labelled deoxyuridine uptake is less marked than that observed with normoblastic cells and to achieve similar results requires folic acid. These findings suggest that reduced deoxyuridylate conversion to deoxythymidylate by thymidylate synthetase is appropriate to explain the 'deoxyuridine suppression test' in megaloblastic marrow cells and that altered substrate requirements for this activity may occur in megaloblastic cells.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Methotrexate; Thymidine; Thymidylate Synthase; Vitamin B 12; Vitamin B 12 Deficiency

A 34-year-old Black woman had severe megaloblastic anemia in childhood. Initially, and over the years, she responded well to massive doses of parenteral cobalamin (Cbl) or oral folic acid. Metabolic reactions involving Cbl and folate enzymes were normal during both relapse and remission except for the absence of thymidylate synthetase in relapse. Amino acid analyses of urine and plasma showed no significant abnormalities. Neither cystathionine, homocystine, formiminoglutamic acid, nor methylmalonic acid was detected in the urine. The serum Cbl level was repeatedly elevated even when the patient was receiving only folic acid therapy. The elevation of the vitamin in the serum was found to be a result of markedly increased levels of transcobalamin II (TC II), as identified by several physicochemical techniques. The patient's TC II-Cbl shared immunologic properties with normal TC II but did not facilitate or impede the uptake of Cbl or Cbl bound to normal TC II, respectively, by human cells.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Blood Proteins; Female; Folic Acid; HeLa Cells; Humans; Hypergammaglobulinemia; Lymphocytes; Middle Aged; Protein Binding; Transcobalamins; Vitamin B 12

Charts of 122 patients with megaloblastic anemia due to either B12 or folic acid deficiency were reviewed for the presence of fever. Fever, defined as a temperature of 100 F (37.8 C) or more, was present in approximately 40% of the patients with both. The elevation was usually minimal but was sometimes over 104 F (40 C), usually in those with more severe anemia and thrombocytopenia, and greater elevations of SGOT and bilirubin concentration. In uncomplicated cases, the temperature returned rapidly to normal after adequate vitamin therapy. Failure of the fever to disappear rapidly with treatment should suggest the probability of some cause other than megaloblastic anemia.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Fever; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Autoantibodies; Diagnosis, Differential; FIGLU Test; Gastric Juice; Gastritis; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Intrinsic Factor; Prognosis; Vitamin B 12

We have studied a patient, unrelated to the patients previously described, with inherited lack of the vitamin B12 binding protein Transcobalamin II. Severe haematological abnormalities were found within a few weeks of birth and responded to treatment with both vitamin B12 and folic acid. He was maintained in partial remission with such treatment until adolescence, except for a time in early childhood when folic acid alone was given and he suffered severe neurological deterioration. A the age of 18 years he was admitted to hospital because of convulsions; the deoxyuridine suppression test showed intracellular deficiency of B12 despite a normal serum B12 and normal haemoglobin concentration. His serum failed to promote the uptake of radioactive B12 by bone marrow cells, and analysis of serum B12 binding proteins demonstrated the lack of Transcobalamin II. Treatment with injections of 1000 micrograms of B12 three times weekly corrected the abnormality shown in the deoxyuridine suppression test; following this treatment, together with changes in anticonvulsive therapy, he remains healthy without occurrence of further convulsions, and is haematologically normal.

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Proteins; Bone Marrow; Deoxyuridine; Folic Acid; Humans; Intestinal Absorption; Male; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Intestinal Absorption; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Child; Female; Humans; Intrinsic Factor; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Child; Child, Preschool; Female; Humans; Infant; Male; Proteinuria; Syndrome; Vitamin B 12

Various factors led to delays of several months to several years in the diagnosis of pernicious anemia in 11 patients, occasionally with serious consequences. These cases illustrate that earlier diagnosis is possible with closer attention to abnormal results of common tests. Macrocytosis, detected by high mean corpuscular volume, often preceded anemia but was not investigated, especially when anemia was only slight. Several cases demonstrated that vitamin B12 deficiency may initially produce only a mild macrocytic anemia, which is maintained for a long period before a rapid worsening supervenes; the reason for the latter acceleration of anemia is unknown. Most serious was the evidence that mild anemias are often ignored. Stricter attention to the established limits of normal hemoglobin values is required. These aspects of physician performance have implication for the recognition of all anemias.

Topics: Aged; Anemia; Anemia, Macrocytic; Anemia, Pernicious; Female; Humans; Male; Middle Aged; Vitamin B 12

Report on a case of severe megaloblastic anemia in a vegetarian, associated with marked erythroleukemic blood findings probably caused by infections (bronchopneumonia, asthmatic bronchitis, urinary tract infection) and severe heart failure. Successful treatment of the above mentioned complications resulted in almost complete disappearance of pathologic cells from the blood even before vitamin B12 treatment was started. With this therapy complete recovery was achieved and the signs suspect for erythroleukemia in blood and bone marrow disappeared definitively. The case also fulfilled all the criteria of pernicious anemia (Schilling's test and determination of intrinsic factor were not done).

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Examination; Digitalis Glycosides; Diuretics; Female; Folic Acid; Heart Failure; Humans; Leukemia, Erythroblastic, Acute; Obesity; Vitamin B 12; Vitamin B 12 Deficiency

Deoxyuridine suppression of labelled thymidine uptake tests were performed in the bone marrows of 58 patients with megaloblastic anaemia (haemoglobin less than 10.0 g/dl) and invariably gave values (range 10.3-58.8%) above the range in 16 control marrows (range 1.0-9.0%). Folinic acid corrected the test equally well in either folate or vitamin B12 deficiency, even at concentrations as low as 60 ng/ml. Folic acid also corrected the test equally well in either deficiency but was only effective at concentrations down to 5 microgram/ml. Vitamin B12 (100 microgram/ml) only corrected the test in vitamin B12 deficiency and 5-methyltetrahydrofolate only corrected the test in folate deficiency at the concentrations tested between 60 and 1.2 microgram/ml. Among 16 patients with subnormal serum levels of both vitamin B12 and folate, vitamin B12 partially corrected the test in eight, including all five with pernicious anaemia, but had no effect in the other eight. Despite the clear-cut results of the dU suppression test, measurement of the deoxythymidine triphosphate (dTTP) concentration in normal and megaloblastic phytohaemagglutinin stimulated lymphocyte cultures or short-term bone marrow cultures gave no clear-cut differences between normal and megaloblastic cells after addition of deoxyuridine nor did the addition of vitamin B12, folic acid or folinic acid either alone or with deoxyuridine produce consistent changes in the dTTP concentration in lymphocytes or bone marrow cells in megaloblastic anaemia. Alcohol caused a rise in deoxyadenosine triphosphate concentration in normal PHA-stimulated lymphocytes which was concentration dependent but caused no consistent change in any of the other three deoxynucleoside triphosphate (dNTP) concentrations. Diphenylhydantoin (10(-3)M, 10(-4)M) had no consistent effect on any of the four dNTP concentrations.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Cells, Cultured; Deoxyadenine Nucleotides; Deoxyuridine; DNA; Ethanol; Folic Acid; Humans; Leucovorin; Lymphocytes; Tetrahydrofolates; Thymidine; Thymine Nucleotides; Vitamin B 12

The utilization of [14C]formate for serine synthesis by lymphocytes was impaired in all the patients with pernicious anaemia and in 70% of other patients with megaloblastic anaemia. In pernicious anaemia this was corrected by vitamin B12 therapy in 48 h but not by folate therapy although patients given folate showed a satisfactory haematological response.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Folic Acid; Folic Acid Deficiency; Formates; Humans; In Vitro Techniques; Lymphocytes; Serine; Vitamin B 12; Vitamin B 12 Deficiency

Serum ferritin concentrations have been estimated in 30 patients with untreated megaloblastic anaemia, 27 with Addisonian pernicious anaemia. A significant difference was found between the mean serum ferritin level of the 27 pernicious anaemia patients (330 microgram/1) and of 22 normal control subjects (164 microgram/1) (P less than 0.05 greater than 0.02). There was an inverse correlation between serum ferritin and Hb concentration in men with pernicious anaemia but not in women. Serum ferritin levels were lower in 10 of 13 patients studied after 24 h of vitamin B12 therapy and in all 13 studied at 48 h after therapy. The fall continued during the haematological response to therapy. It seems likely that serum ferritin reflects reticuloendothelial iron and the high levels in untreated megaloblastic anaemia are due to the shift in iron from Hb to reticuloendothelial stores. The wide variation in serum ferritin at any given Hb level presumably reflects variation in iron stores of the individual patient.

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Child, Preschool; Female; Ferritins; Hemoglobins; Humans; Male; Middle Aged; Sex Factors; Vitamin B 12

Most, but not all, megaloblastic anemia is produced by "ineffective erythropoiesis" in the bone marrow due to either folic acid or vitamin B12 deficiency. In folic acid deficiency the cause frequently is inadequate dietary intake, whereas vitamin B12 deficiency is almost always conditioned by some specific type of malabsorption. Anemia with oval macrocytes, few reticulocytes, moderate leukopenia, and thrombocytopenia is typical of both. Aplastic anemia, refractory anemias with cellular marrow, preleukemia, aleukemia, and erythroleukemia may have somewhat similar blood findings but are usually recognizable from bone marrow biopsy. Decreased levels of folate or vitamin B12 are the most reliable criteria of megaloblastic anemia. With these available in advance, therapy with the appropriate vitamin can be begun at once. If serum levels are unavailable or available only in retrospect, initial treatment, especially of severe anemia, should be with both vitamins. Differentiation between folate and vitamin B12 deficiency is important but impossible by blood and bone marrow morphology alone. Thus, if serum levels are unavailable, the distinction must be made, sometimes retrospectively, on the basis of other laboratory examinations, such as gastric analysis, small-bowel x-ray films, and the Schilling test.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Breast Feeding; Diet, Vegetarian; Female; Humans; Infant; Infant, Newborn; Male; Nutrition Disorders; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Autoantibodies; Bone Marrow; Folic Acid; Humans; Male; Vitamin B 12

Topics: Adolescent; Anemia, Macrocytic; Anemia, Megaloblastic; Drug Therapy, Combination; Female; Folic Acid; Humans; Infant; Leucovorin; Vitamin B 12

Topics: Adenine Phosphoribosyltransferase; Anemia, Macrocytic; Anemia, Megaloblastic; Erythrocytes; Folic Acid; Humans; Hypoxanthine Phosphoribosyltransferase; Hypoxanthines; Purines; Reticulocytes; Ribose-Phosphate Pyrophosphokinase; Uric Acid; Vitamin B 12; Xanthines

Pancytopenia developed in four patients receiving postoperatively total parenteral nutrition (TPN). Symptoms and signs were related mainly to underlying bowel disease. Hematologic abnormalities, first noted from 4 to 7 weeks following institution of TPN, consisted of normocytic anemia (mean decrease in hemoglobin value, 2.2 g/dL), occasional macrocytes being noted, leukopenia (range of leukocyte counts, 1.2 to 3.6 X 10(9) L), some hypersegmented neutrophils being detected, and clinically significant thrombocytopenia (range of platelet counts, 25 to 52 X 10(9)/L). In all patients the bone marrow showed megaloblastic changes, with ring sideroblasts, although pyridoxine was included in the TPN regimens. Serum vitamin B12 values were normal in one patient and at the lower limit of normal in the other two patients in whom it was measured, while serum or erythrocyte folate values, or both, were reduced in three patients. Full hematologic response was observed in the four patients after folic acid replacement therapy; leukocytosis and thrombocytosis were noted in three. Thus, folic acid and possibly vitamin B12 should be added routinely to TPN regimens to prevent deficiency of either substance.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Humans; Parenteral Nutrition; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Cobamides; Humans; Malonates; Metabolism, Inborn Errors; Methylmalonic Acid; Vitamin B 12; Vitamin B 12 Deficiency

In most cases megaloblastic anaemias are the sequel of a deficiency of vitamin B12, more infrequently of a deficiency of folic acid of different etiology. Oriented to frequency and anamnesis the diagnostics follows the leading symptoms of pernicious anaemia (straw colour, glossitis, achlorhydria) and on the basis of special findings in the peripheral blood (hyperchromacia, megalocytosis, much decreased number of reticulocytes, increased iron and bilirubin level) it leads to the proved suspicion of a megaloblastic anaemia. This suspicion is ascertained by the investigation of the bone-marrow, with the help of aimed investigations the anaemia is further clarified differential-diagnostically. An unclear anaemia should not be treated ex juvantibus with vitamin B12 and/or folic acid. The therapy, always taking into consideration a possible basic disease, is carried out by parenteral application of vitamin B12, possibly in form of hydroxocobalamine or by folic acid. In persisting disturbance of the resorption of vitamin B12 on account of the threatening complication of a funicular spinal disease the long-term therapy must never be interrupted, unless in normal haematological findings.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Diagnosis, Differential; Humans; Intrinsic Factor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Ascorbic Acid; Bone Marrow Diseases; Female; Humans; Iron; Male; Pyridoxine; Vitamin B 12

In 11 patients with megaloblastic anemia, transfusion of packed erythrocytes or washed erythrocytes invariably resulted in a decline in plasma iron concentration to a range of 20-90 microgram/dl (3.6-16 mumol/l) after 36 to 48 hours. The same phenomenon was observed in two of six cases of ineffective erythropoiesis without megaloblastosis and in none of five cases of aplastic anemia. The observed changes did not result from a specific hematinic response or from iron uptake by a non-erythroid compartment. In megaloblastic anemia, alteration in marrow function in response to transfusion was reflected by plasma iron kinetics and serum lactate dehydrogenase values, which indicated marked reductions in both marrow hyperplasia and ineffective erythropoiesis. Transfusion in megalobastic anemia was also responsible for a 50% reduction in platelet count after 2 to 6 days. The significance of these changes is discussed.

Topics: Adult; Aged; Anemia; Anemia, Aplastic; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Cell Count; Blood Platelets; Blood Transfusion; Female; Folic Acid; Humans; Iron; L-Lactate Dehydrogenase; Male; Middle Aged; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant, Newborn; Infant, Newborn, Diseases; Obstetric Labor Complications; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12

Three cases of congenital selective malabsorption of vitamin B12 (Imerslund-Grasbeck syndrome) are presented. Pathophysiological aspected and clinical symptoms of this disease are discussed together with other megaloblastic anaemias in childhood caused by vitamin B12 deficiency.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Chronic Disease; Female; Humans; Infant; Intestinal Absorption; Recurrence; Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Red cell anisocytosis as assessed using the Coulter Channelyzer C-1000 showed an increase with progressive anaemia in 25 patients with macrocytosis due to B12 and/or folate deficiency. In deficiency of a single factor, the degree of anisocytosis increased with progressive anaemia. In five cases with B12 and folate deficiency combined, anisocytosis was markedly increased out of proportion to the degree of anaemia present. Iron stores were also reduced in four of these cases. It is suggested that objective measurement of anisocytosis is of early diagnostic value in the assessment of multiple haematinic factor deficiency, for example, in macrocytic anaemia associated with malabsorption states and unexpected multiple deficiency states.

Topics: Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Erythrocyte Count; Erythrocytes, Abnormal; Female; Folic Acid; Hemoglobins; Humans; Iron; Male; Vitamin B 12

Topics: Anemia, Macrocytic; Biopsy; Chronic Disease; Humans; Infant; Intestinal Mucosa; Intestine, Small; Malabsorption Syndromes; Male; Syndrome; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Diet; Diphyllobothriasis; Diphyllobothrium; Finland; Humans; Vitamin B 12

Thymidine kinase has been measured in phytohaemagglutinin (PHA)-stimulated lymphocytes from 13 normal subjects and eight patients with megaloblastic anaemia. The levels in normal subjects ranged from 0.20 to 2.10 units/mg protein (mean 0.903 units/mg protein) and in megaloblastic anaemia from 2.99 to 9.97 units/mg protein). All the patients showed raised levels of the enzyme which were partly but not completely reduced to normal by addition of folic acid in vitro. Vitamin B12 in vitro had a lowering effect in the five vitamin-B12-deficient patients and two patients with combined deficiencies but not in one 'pure' folate-deficient patient. Thymidine kinase activity was highest in the cells of the least anaemic patients, suggesting that the degree of anaemia in megaloblastic anaemia may be determined in part by the ability of the cells to utilize thymidine by the 'salvage' pathway when the de novo pathway of thymidylate synthesis is failing. The rise in thymidine kinase activity in megaloblastic anaemia is presumably due to induction of the enzyme. Addition of methotrexate or 5-fluorouracil, drugs known to inhibit de novo thymidylate synthesis, caused an increase in thymidine kinase activity in normal PHA-stimulated lymphocytes after 24 h (but not after 1 h) which could be completely blocked by addition of puromycin. Thymidine mono- and di-phosphate kinases were also measured in normal PHA-stimulated lymphocytes. The activities were substantially higher than that of thymidine kinase and their activities were unaffected by methotrexate addition.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Female; Fluorouracil; Folic Acid; Folic Acid Deficiency; Humans; Lectins; Lymphocyte Activation; Male; Methotrexate; Puromycin; Sonication; Thymidine Kinase; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Chronic Disease; Female; Humans; Recurrence; Syndrome; Vitamin B 12

Transcobalamins are proteins which carry vitamin B12 and which are normally partly unsaturated. This study of transcobalamins was carried out in 17 subjects with megaloblastic anemia (12 true cases of pernicious anemia and 5 cases of folate deficiency). Among the latter, the transcobalamins were studied in 4 cases of pernicious anemia, before and after treatment with vitamin B12. The distribution of endogenous B12 was determined in four normal controls and two cases of pernicious anemia. This vitamin is normally distributed roughly equally between the three transcobalamins, whereas in B12 deficiency, T.C.2 is very unsaturated together with T.C.1 to a lesser degree. The latent fixation capacity of the serum is increased together with the latent fixation capacity of T.C. I and, above all, T.C. II but that of T.C. III is reduced in patients with pernicious anemia. In folate deficiency, only the latent fixation capacity of T.C. II is increased. When vitamin B12 is administered in physiological dosage, T.C. I becomes gradually saturated. In pharmacological dosage, total fixation capacity together with that of T.C. I and T.C. II become gradually reduced, but in spite of high levels of circulating B12, these proteins remain partially unsaturated. Various theories are suggested to explain the variations of these three transcobalamins in megaloblastic anemia but the problem is still unclear.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Blood Proteins; Folic Acid; Folic Acid Deficiency; Humans; Kinetics; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

The diagnostic interest of a search for anti-intrinsic factor antibodies is emphasized from the authors research on more than 200 patients or controls. Antibodies of type I, so-called blocking antibodies, were detected in 66% of cases where the diagnosis of pernicious anemia was made. Type II, so-called precipitating antibodies, were found in 47% of patients with antibodies of type I and only in the latter. Certain etiological factors, already noted in the world literature, were found, in particular the link with the female sex and with blood group A. The specificity of these antibodies is very great and false positives are exceptional. We did not find them in any of the 104 controls. They were observed, however, in 5 of the 56 patients where the diagnosis of pernicious anemia was not definite, but it is likely that, in these 5 cases, pernicious anemia existed with some other disease. Our study also showed the limits of other methods of investigation of this disease; hypovitaminimia B12 is often corrected by treatment without proper inductions and B12 malabsorption on the Schilling test may not be corrected by the addition of intrinsic factor.

Topics: Anemia, Macrocytic; Anemia, Pernicious; Antibody Specificity; Autoantibodies; Autoimmune Diseases; Blood Group Antigens; Diagnosis, Differential; False Positive Reactions; Female; Gastric Juice; Hematologic Diseases; Humans; Immunodiffusion; Intrinsic Factor; Male; Precipitins; Radioimmunoassay; Schilling Test; Sex Factors; Vitamin B 12

Recurrent nonspecific stomatitis may be an oral sign of pernicious anemia. Repeated examinations and blood studies are important when the cause of stomatitis is not clear on initial evaluation of a complaint of sore mouth. Three cases of pernicious anemia are presented to illustrate the similarities and differences in oral signs of pernicious anemia.

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Candida albicans; Candidiasis, Oral; Female; Glossitis; Humans; Male; Middle Aged; Nystatin; Stomatitis; Vitamin B 12

Because virtually all cases of vitamin B12 deficiency seen in this country are due to malabsorption, the availability of radioactive vitamin B12 for direct measurement of absorption of this essential nutrient has proved to be of great clinical value. These tests are useful not only in demonstrating vitamin B12 malabsorption but also often in defining the pathophysiological mechanism responsible for this abnormality. The urinary excretion test of Schilling remains the most useful test for vitamin B12 absorption. Minor precautions and modifications in technique make the test results more reliable and easier to interpret. The 8-hr plasma test for vitamin B12 absorption can no longer be considered acceptable. Some patients with vitamin B12 malabsorption have results in the normal range when studied by this method. Serum vitamin B12 assays utilizing radioactive vitamin B12 and the isotope dilution principle are not widely used and are useful screening tests. Low normal or borderline results observed in patients with clinical evidence suggestive of vitamin B12 deficiency should be interpreted with caution or confirmed by radioactive vitamin B12 absorption studies. Radioactive vitamin B12 can also be used for rapid, reliable assay of gastric intrinsic factor, antibody to intrinsic factor and unsaturated vitamin B12 serum. Methods using radioactive folate compounds for similar in vivo and in vitro studies are not yet applicable for routine use in nuclear medicine laboratories.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Cobalt Radioisotopes; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intrinsic Factor; Radioimmunoassay; Radioisotope Dilution Technique; Schilling Test; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Child; Chronic Disease; Follow-Up Studies; Humans; Male; Recurrence; Syndrome; Vitamin B 12

The occurrence of anemia in a group of aged persons residing in a home for the aged and in a chronic disease hospital was reviewed with regard to etiology, choice of treatment, and therapeutic response. Of the 484 patients, 151 (31 per cent) had anemia or were receiving antianemia therapy. Iron-deficiency anemia was the most common type, and iron was the most common form of treatment. Seventy-eight patients were given antianemia therapy in 97 courses, and a good therapeutic result was achieved in about one-fourth of the courses. The most frequent error in iron therapy was its use in the anemia associated with chronic disorders. Often there was a combination deficiency of iron, vitamin B12 and folic acid. The response to iron in the elderly can be very slow, so therapy should not be discontinued too soon. Anemia may directly contribute to other serious pathologic conditions, especially in aged persons with impaired circulation. In some cases the physiologic concentration of hemoglobin may be higher than the accepted "normal" value. The course of the anemia in relation to the general state of the patient is more significant than any laboratory data in choosing antianemia therapy. Practical laboratory screening procedures for elderly anemic patients are discussed.

Topics: Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Chronic Disease; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Male; Vitamin B 12

We have described a case of chronic arsenic intoxication associated with pancytopenia and megaloblastic erythropoiesis. The patient had the typical laboratory manifestations of effective erythorpoiesis due to a megaloblastic process, including macroovalocytes, mild pancytopenia, low reticulocyte index, increased marrow cellularity with erythroid hyperplasia, and morphologic evidence of megaloblastic maturation in the marrow. The patient's serum folate and vitamin B12 were normal, and the anemia regressed without therapy. Our case suggests that the combination of megaloblastosis with normoblastic or megaloblastic karyorrhexis,should raise the suspicion of arsenic intoxication in the mind of the observer. In addition, arsenic should be added to the list of agents causing a reversible megaloblastic anemia.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Arsenic; Arsenic Poisoning; Bone Marrow Examination; Erythropoiesis; Folic Acid; Hair; Humans; Keratosis; Liver; Male; Middle Aged; Nails; Neural Conduction; Neurologic Manifestations; Remission, Spontaneous; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Gastrectomy; Humans; Ileum; Intrinsic Factor; Malabsorption Syndromes; Metabolism, Inborn Errors; Schilling Test; Time Factors; Vitamin B 12

Topics: Administration, Oral; Anemia, Macrocytic; Anemia, Megaloblastic; Diagnosis, Differential; DNA; Electroencephalography; Electromyography; Folic Acid Deficiency; Humans; Mental Disorders; Syndrome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Deficiency

The return of the MCV to normal after treatment in megaloblastic anaemia follows a biphasic pattern. The initial more rapid decline in MCV is due to disappearance of pretreatment macrocytes from the circulation and the rate of fall is determined by their mean cell life. The second slower component is probably due to a mixture of pretreatment macrocytes and new macrocytes, the result of a young red cell population. The MCV often returned to normal most rapidly in the most severely megaloblastic patients due to a very short mean red cell life span. However, there was no significant correlation between either initial MCV or red cell count and the time after treatment for a return of a normal MCV.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Erythrocytes, Abnormal; Folic Acid; Humans; Hydroxocobalamin; Time Factors; Vitamin B 12

Two cases of Imerslund's disease are reported, with special reference to the treatment with vitamin B 12. Data suggest that mean corpuscular volume and urinary excretion of methylmalonic acid are the most sensitive parameters to follow the effect of the treatment and predict the relapse.

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Child; Female; Humans; Malabsorption Syndromes; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid Deficiency; Child; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Infant; Intestinal Diseases; Malabsorption Syndromes; Nutritional Physiological Phenomena; Nutritional Requirements; Orotic Acid; Pregnancy; Pregnancy Complications; Tetrahydrofolate Dehydrogenase; Thiamine Deficiency; Transferases; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin E Deficiency

Topics: Adult; Anemia, Macrocytic; Biological Transport; Carrier Proteins; Diarrhea; Electrophoresis, Polyacrylamide Gel; Female; Humans; Immunodiffusion; Immunoelectrophoresis; Immunologic Deficiency Syndromes; Infant, Newborn; Injections, Intramuscular; Malabsorption Syndromes; Metabolism, Inborn Errors; Pregnancy; Protein Binding; Radioisotopes; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Blood Cell Count; Diet, Vegetarian; Drug-Related Side Effects and Adverse Reactions; Folic Acid; Folic Acid Deficiency; Humans; Hydroxocobalamin; Intestinal Diseases; Potassium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Anemia, Megaloblastic; Drug Combinations; Female; Folic Acid Deficiency; Hemorrhage; Humans; Infectious Mononucleosis; Pyrimethamine; Sulfamethoxazole; Trimethoprim; Vitamin B 12

Topics: Administration, Oral; Adolescent; Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Child; Diet Therapy; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Injections, Intramuscular; Intestinal Absorption; Intestine, Small; Male; Middle Aged; Nucleoproteins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Diagnosis, Differential; Female; Humans; Intestinal Absorption; Intrinsic Factor; Male; Middle Aged; Schilling Test; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Edema; Female; Folic Acid; Humans; Lactation; Malabsorption Syndromes; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Heinz Bodies; Humans; Postoperative Complications; Splenectomy; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Asthenia; Body Weight; Diarrhea; Feeding and Eating Disorders; FIGLU Test; Folic Acid; Folic Acid Deficiency; Gingivitis; Humans; Leukopenia; Liver; Male; Malonates; Papio; Thrombocytopenia; Vitamin B 12

Topics: Anemia, Macrocytic; Erythrocytes; Folic Acid; Humans; Protein Binding; Radioligand Assay; Tritium; Vitamin B 12

Two siblings with megaloblastic anemia responsive to parenteral vitamin B(12) were studied to elucidate the cause of the B(12) deficiency. Gastric juice from both contained acid and functional intrinsic factor. Serum contained transcobalamin II and lacked antibodies to intrinsic factor. Schilling tests showed vitamin B(12) malabsorption uncorrected by hog intrinsic factor or pancreatic extract. Other parameters of small intestinal function were normal. Proteinuria was initially present in both but cleared in one following treatment with B(12). These patients with "familial selective vitamin B(12) malabsorption" are the first reported from Canada. Only 37 cases have been reported in the world literature to date.

Topics: Anemia, Macrocytic; Child; Child, Preschool; Cobalt Radioisotopes; Female; Follow-Up Studies; Gastric Juice; Humans; Intestinal Absorption; Intrinsic Factor; Male; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hemolytic; Anemia, Macrocytic; Anemia, Pernicious; Erythrocytes, Abnormal; Folic Acid; Folic Acid Deficiency; Humans; Leukemia; Liver Cirrhosis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Alanine; Amino Acids; Anemia, Macrocytic; Child; Chromatography, Gas; Glycine; Hemoglobins; Histidine; Humans; Isoleucine; Leucine; Malabsorption Syndromes; Male; Malonates; Methionine; Proteinuria; Renal Tubular Transport, Inborn Errors; Reticulocytes; Serine; Taurine; Threonine; Tyrosine; Valine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Anemia, Macrocytic; Cobalt Radioisotopes; Humans; Intestinal Absorption; Schilling Test; Time Factors; Vitamin B 12

Topics: Anemia, Macrocytic; Biological Assay; Costs and Cost Analysis; Folic Acid; Humans; Scotland; Vitamin B 12

Topics: Anemia, Macrocytic; Atrophy; Autopsy; Blood Vessels; Brain; Brain Chemistry; Cerebrosides; Child; Cholesterol; Chromatography, Thin Layer; Demyelinating Diseases; Esters; Fatty Acids; Fatty Acids, Unsaturated; Female; Galactose; Gliosis; Globus Pallidus; Homocystinuria; Humans; Malonates; Metabolism, Inborn Errors; Phosphatidylcholines; Phospholipids; Sphingomyelins; Sulfoglycosphingolipids; Vitamin B 12

Topics: Amino Acid Isomerases; Amino Acids; Anemia, Macrocytic; Autopsy; Brain; Brain Chemistry; Cells, Cultured; Child; Culture Media; Fibroblasts; Homocysteine; Humans; Intellectual Disability; Liver; Lung; Lyases; Malonates; Metabolism, Inborn Errors; Methionine; Spleen; Vitamin B 12

Topics: Achlorhydria; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Antibodies; Erythrocyte Count; Folic Acid; Histamine; Humans; Intrinsic Factor; Malabsorption Syndromes; Middle Aged; Pentagastrin; Reticulocytes; Schilling Test; South Africa; Stimulation, Chemical; Syndrome; Tetracycline; Vitamin B 12

Topics: Anemia, Aplastic; Anemia, Macrocytic; Anemia, Sideroblastic; Bone Marrow Examination; Erythrocytes; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Hematocrit; Humans; Lacticaseibacillus casei; Lactobacillus; Methods; Myxedema; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Chloramphenicol; Cyclic AMP; Cycloheximide; Dactinomycin; DNA; Edetic Acid; Female; Folic Acid Deficiency; Hematopoiesis; Humans; Lectins; Leukocytes; Lymphocyte Activation; Lymphocytes; Male; Middle Aged; Puromycin; RNA; Theophylline; Time Factors; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Thirteen cases are described of temporary malabsorption in adults presenting after an episode of apparent infective enteritis. Clinical features included diarrohea, anorexia, and weight loss. Investigations indicated diffuse impairment of function in the small bowel, including the ileum, with well-preserved mucosal morphology in the upper jejunum and a tendency to rapid folate depletion. Spontaneous recovery usually occurred within weeks but two cases ran a more prolonged and severe course.The clinical features of this syndrome are those of tropical sprue, but the outcome of the illness is probably influenced by nutritional as well as environmental factors. There may be a gradation of severity of illness from megaloblastic anaemia to florid malabsorption syndrome.

Topics: Adult; Agglutination Tests; Anemia, Macrocytic; Body Weight; Diarrhea; Enteritis; Feeding and Eating Disorders; Folic Acid Deficiency; Humans; Ileum; Intestine, Small; Jejunum; Malabsorption Syndromes; Middle Aged; Sprue, Tropical; Vitamin B 12

Topics: Administration, Oral; Anemia, Macrocytic; Child; Consanguinity; Female; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Intestinal Absorption; Leucovorin; Metabolism, Inborn Errors; Recurrence; Stomatitis; Vitamin B 12; Yeast, Dried

Topics: Anemia, Macrocytic; Blood Proteins; Bone Marrow; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infant Nutrition Disorders; Kwashiorkor; Male; Myelography; Protein-Energy Malnutrition; Vitamin B 12

Topics: Aged; Alcoholism; Anemia, Macrocytic; Anemia, Pernicious; Female; Folic Acid; Hematocrit; Hemoglobins; Humans; Male; Middle Aged; Phenytoin; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Cell Nucleus; Child; Female; Humans; Intrinsic Factor; Pigmentation Disorders; Skin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amino Acids; Anemia, Macrocytic; Anemia, Pernicious; Autoradiography; Electrophoresis, Disc; Hematopoietic Stem Cells; Histones; Humans; Lysine; Schilling Test; Tritium; Tryptophan; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Sickle Cell; Child; FIGLU Test; Folic Acid; Folic Acid Deficiency; Growth Disorders; Hemoglobinometry; Histidine; Humans; Intestinal Absorption; Male; Recurrence; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Bone Marrow; Bone Marrow Cells; Cells, Cultured; Deoxyuridine; DNA; Folic Acid; Humans; Thymidine; Thymine Nucleotides; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Age Factors; Aged; Anemia, Macrocytic; Anemia, Pernicious; Autoantibodies; Black or African American; Black People; Diagnosis, Differential; Ethnicity; Folic Acid; Gastric Juice; Humans; Intrinsic Factor; Malabsorption Syndromes; Middle Aged; South Africa; Syndrome; Tetracycline; Vitamin B 12

Topics: Alcoholism; Anemia, Macrocytic; Electronics, Medical; Erythrocytes; Folic Acid; Folic Acid Deficiency; Humans; Liver Diseases; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; In Vitro Techniques; Iodine Isotopes; Methods; Thymidine; Thymine; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Haemoglobin, serum vitamin B(12), and serum and red cell folate levels have been measured in 322 pregnant immigrant women in London at their first booking and in a proportion at 34 weeks of gestation and postnatally. The Indian, East-African Indian, and Pakistani and Bangladeshi patients showed significantly lower initial mean serum vitamin B(12) levels than the European group, the levels being lower in Hindu and Sikh patients than in Moslems. The patients of West Indian, Indian, and East-African Indian origin showed significantly lower initial mean haemoglobin levels than the immigrants from European countries. Though there was no overall correlation between haemoglobin and serum vitamin B(12) level the incidence of hypersegmented polymorphs and macrocytosis in the peripheral blood was highest in the Indian and East-African Indian patients, and both these features were particularly frequent in patients with subnormal serum vitamin B(12) levels. Only one patient, however, had overt megaloblastic anaemia due to vitamin B(12) deficiency. The Indian patients whose red cell folate levels were less than 200 ng/ml also had a lower mean serum vitamin B(12) level than those with red cell folate levels greater than 200 ng/ml. The Indian patients had smaller babies than the Europeans but this was not related to the differences in vitamin B(12) status between the two groups. However, out of 39 babies of the Indian group 5 (13%) showed subnormal serum vitamin B(12) levels in the first 10 days of life, the lowest level being 120 pg/ml.Though there was an overall statistically significant fall in serum vitamin B(12) between first booking and 34 weeks of pregnancy there was no significant fall in serum vitamin B(12) in those who initially had subnormal levels. Thus many Indian women are vitamin B(12) deficient in pregnancy, and this is associated with morphological blood abnormalities in many cases, but megaloblastic anaemia due to this deficiency is relatively infrequent.

Topics: Africa, Eastern; Age Factors; Anemia, Macrocytic; Bangladesh; Birth Weight; Emigration and Immigration; Erythrocytes; Ethnicity; Female; Folic Acid; Hemoglobinometry; Humans; India; Pakistan; Parity; Pregnancy; Pregnancy Complications, Hematologic; Time Factors; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Cobalt Isotopes; Feces; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Bone Marrow; Female; Folic Acid; Humans; Hydroxyurea; Leukopenia; Male; Middle Aged; Psoriasis; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Erythropoiesis; Female; Folic Acid; Hematopoietic System; Humans; Iron; Iron Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Vitamin B 12

Topics: Anemia, Macrocytic; Female; Fetus; Glycoproteins; Humans; Ileum; Intrinsic Factor; Malabsorption Syndromes; Pregnancy; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Epilepsy; Folic Acid; Folic Acid Deficiency; Humans; Phenobarbital; Phenytoin; Primidone; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Diphosphoglyceric Acids; Erythrocytes; Folic Acid; Hemoglobins; Humans; Kinetics; Oxygen; Vitamin B 12

Topics: Anemia, Macrocytic; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Brain Diseases; Folic Acid Deficiency; Humans; Intestinal Obstruction; Jejunum; Malabsorption Syndromes; Male; Neurologic Manifestations; Time Factors; Vitamin B 12

Topics: Adolescent; Anemia, Macrocytic; Celiac Disease; Cobalt Isotopes; Dietary Fats; Feces; Female; Gastric Juice; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Malabsorption Syndromes; Male; Middle Aged; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Erythrocytes; Glutathione; Hemoglobinometry; Humans; Peroxidases; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Child; Cobalt Radioisotopes; Folic Acid; Hemoglobins; Humans; Male; Reticulocytes; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Mental Disorders; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Ascorbic Acid; Blood Cell Count; Blood Proteins; Bone Marrow Cells; Cell Nucleus; Erythrocytes, Abnormal; Female; Folic Acid; Hemoglobinometry; Humans; Iodine; Iron; Leukocytes; Male; Neutrophils; Protein Binding; Vitamin B 12

Topics: Anemia, Aplastic; Anemia, Macrocytic; Blood Cell Count; Folic Acid; Folic Acid Deficiency; Humans; Iron; Middle Aged; Nalidixic Acid; Nutrition Disorders; Pyelonephritis; Sulfamethoxazole; Trimethoprim; Urea; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Child, Preschool; Humans; Infant; Intestinal Absorption; Intestine, Small; Male; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Drug-Related Side Effects and Adverse Reactions; Gastrectomy; Humans; Intestine, Small; Leukopenia; Middle Aged; Thrombocytopenia; Vitamin B 12

Topics: Administration, Oral; Adolescent; Adult; Anemia, Macrocytic; Diet; Emigration and Immigration; England; Feeding Behavior; Female; Folic Acid; Humans; India; Male; Middle Aged; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Asia; Blood Proteins; Female; Folic Acid; Humans; Iron; Male; Nutrition Surveys; Nutritional Physiological Phenomena; United Kingdom; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Folic Acid; Iron; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Diet, Reducing; Female; Folic Acid Deficiency; Humans; Protein Deficiency; Starvation; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Blood Proteins; Female; Hematologic Diseases; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukocyte Count; Liver Cirrhosis; Lupus Erythematosus, Systemic; Lymphoma; Male; Multiple Myeloma; Neoplasms; Polycythemia; Primary Myelofibrosis; Protein Binding; Uremia; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Biological Assay; Cobalt Isotopes; Erythrocyte Count; Euglena gracilis; Folic Acid; Folic Acid Deficiency; Gastrectomy; Hemoglobins; Humans; Lactobacillus; Methods; Reticulocytes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Alcoholism; Anemia, Macrocytic; Anemia, Pernicious; Blood Cell Count; Bone Marrow Cells; Erythroplasia; Female; Folic Acid; Folic Acid Deficiency; Hematopoietic Stem Cells; Humans; Hypothyroidism; Kidney Diseases; L-Lactate Dehydrogenase; Male; Neutrophils; Nutrition Disorders; Pregnancy; Pregnancy Complications, Hematologic; Reticulocytes; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow; Bone Marrow Examination; Crohn Disease; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Prospective Studies; Recurrence; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Cobalt Isotopes; Female; Humans; Injections, Intramuscular; Intrinsic Factor; Male; Methods; Middle Aged; Schilling Test; Scintillation Counting; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Arthritis, Rheumatoid; Blood Transfusion; Folic Acid; Humans; Male; Thrombocytopenia; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Glucose; Blood Proteins; Folic Acid; Humans; Infant; Iron; Lactose Intolerance; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow; Bone Marrow Cells; Child; Folic Acid Deficiency; Follow-Up Studies; Humans; Infant; Iron; Neutrophils; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Humans; Immunologic Deficiency Syndromes; Intrinsic Factor; Malabsorption Syndromes; Male; Proteinuria; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Ethiopia; Female; Folic Acid; Humans; Male; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Female; Folic Acid; Folic Acid Deficiency; Goats; Humans; Infant; Milk; Vitamin B 12

Topics: Anemia, Macrocytic; Child, Preschool; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Proteins; Bone Marrow Examination; Child Nutritional Physiological Phenomena; Child, Preschool; Erythrocyte Count; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Humans; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Kwashiorkor; Neutrophils; Nutrition Disorders; Nutritional Requirements; Protein Deficiency; Reticulocytes; Serum Albumin; Vitamin B 12; Vitamin E

Four consecutive patients with megaloblastic anaemia who also received therapy with trimethoprim-sulphamethoxazole all showed poor responses to specific haematinic therapy. This was attributed to trimethoprim, which suppressed reticulocyte responses in three cases and produced a pancytopenia in two and a falling haemoglobin with neutropenia in a third. A fourth patient, with pernicious anaemia, had a satisfactory reticulocyte response but experienced no clinical benefit until after withdrawal of trimethoprim.Trimethoprim seems not to be a safe form of therapy in patients with a megaloblastic process; many of the toxic reactions reported with this drug may be on the basis of an unrecognized megaloblastic form of haemopoiesis.

Topics: Adult; Aged; Agranulocytosis; Anemia, Macrocytic; Anemia, Pernicious; Anti-Infective Agents; Arthritis, Rheumatoid; Blood Platelets; Erythrocyte Count; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Middle Aged; Pyrimidines; Reticulocytes; Sulfamethoxazole; Tetrahydrofolate Dehydrogenase; Trimethoprim; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Humans; Nervous System Diseases; Neurocognitive Disorders; Neurologic Manifestations; Spinal Cord Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Female; Folic Acid Deficiency; Humans; Pregnancy; Smoking; Vitamin B 12

The possible role of cobalamins in the utilization of serum methyltetrahydrofolate has been investigated by means of radiolabeled methyltetrahydrofolate in subjects suffering from pernicious anemia. After intravenous administration, methyltetrahydrofolate-(3)H (SA 11,500 Ci/mole; dose 0.05 mug/kg) was cleared from the serum to tissues of B(12)-deficient subjects half as fast as after the same subjects had received vitamin B(12) therapy. B(12) deficiency was also associated with an increased rate of renal excretion of methyltetrahydrofolate or its derivatives, and a decreased rate of renal metabolism of methyltetrahydrofolate to other urinary folate derivatives.Intravenously administered methyl-(14)C-tetrahydrofolate-(3)H at a higher dose (5 mug/kg) caused a severalfold elevation of the total serum folate concentration and, in B(12)-deficient subjects, it did not disappear from the serum significantly more slowly although its urinary excretion was significantly increased. These results indicate that there is some cobalamin requirement for the utilization of serum methyltetrahydrofolate and verify one prediction of the "methyltetrahydrofolate trap" explanation for the megaloblastosis of B(12) deficiency.

Topics: Anemia, Macrocytic; Anemia, Pernicious; Carbon Isotopes; Chromatography, Gel; Coenzymes; Folic Acid; Humans; Kidney; Male; Tetrahydrofolates; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Carboxylic Acids; Chromatography, Gas; Ethyl Ethers; Humans; Malonates; Mathematics; Methods; Solubility; Valine; Vitamin B 12

Topics: Anemia, Macrocytic; Diet; Female; Finland; Folic Acid; Humans; Male; Seasons; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Blood Proteins; Carbon Isotopes; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Isomerases; Leukocyte Count; Leukocytes; Male; Malonates; Middle Aged; Neurologic Manifestations; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Blind Loop Syndrome; Hospitals, Psychiatric; Humans; Intellectual Disability; Male; Nutrition Disorders; Polycythemia; Vitamin B 12

Topics: Anemia, Macrocytic; Bone Marrow; Culture Techniques; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Nutritional Physiological Phenomena; Reticulocytes; Thymine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Asian People; China; Diet; Erythrocytes; Erythropoiesis; Ethnicity; Female; Folic Acid; Hemoglobinometry; Humans; India; Malaysia; Neutrophils; Parity; Pregnancy; Pregnancy Complications, Hematologic; Racial Groups; Singapore; Vitamin B 12; Vitamin B 12 Deficiency; White People

Topics: Adolescent; Anemia, Macrocytic; Anemia, Pernicious; Antigens; Chromatography; Chromatography, Gel; Cobalt Isotopes; Gastric Juice; Humans; Intestinal Mucosa; Intrinsic Factor; Isoelectric Focusing; Malabsorption Syndromes; Male; Vitamin B 12

Topics: Anemia, Macrocytic; Carbon; Carbon Dioxide; Carbon Isotopes; Diet; Erythrocyte Count; Folic Acid; Folic Acid Deficiency; Hemoglobins; Histidine; Humans; Injections, Intravenous; Malonates; Oxidation-Reduction; Reticulocytes; Serine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Anemia, Macrocytic; Anemia, Pernicious; Animals; Antibodies; Antibody Specificity; Erythrocyte Count; Gastrectomy; Hematocrit; Humans; Intrinsic Factor; Swine; Vitamin B 12

Topics: Anemia, Macrocytic; Female; Folic Acid; Foot; Hand; Humans; Iron; Middle Aged; Pigmentation Disorders; Vitamin B 12

Topics: Anemia, Macrocytic; Humans; Infant; Infant Nutrition Disorders; Malabsorption Syndromes; Male; Proteinuria; Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Child, Preschool; Female; Growth Disorders; Humans; Intrinsic Factor; Vitamin B 12

Topics: Administration, Oral; Adult; Anemia, Macrocytic; Blood Cell Count; Erythropoiesis; Female; Folic Acid; Humans; Injections, Intravenous; Karyometry; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12

Topics: Adult; Anemia, Hypochromic; Anemia, Macrocytic; Female; Folic Acid; Humans; Pregnancy; Puerperal Disorders; Vitamin B 12

Topics: Abortion, Spontaneous; Anemia, Macrocytic; Blood Transfusion; Congenital Abnormalities; Female; Folic Acid; Folic Acid Deficiency; Humans; Placenta Diseases; Pregnancy; Pregnancy Complications; Prognosis; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Humans; Infant; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Biological Transport; Blood Protein Disorders; Chromatography, DEAE-Cellulose; Chromatography, Ion Exchange; Cobalt Isotopes; Electrophoresis, Disc; Erythrocyte Count; Female; Genes, Recessive; Hematocrit; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pedigree; Protein Binding; Remission, Spontaneous; Reticulocytes; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Bone Marrow; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Neutrophils; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Hypochromic; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Hemoglobins; Humans; Learning; Male; Memory; Psychological Tests; Vitamin B 12; Vitamin B 12 Deficiency; Wales

Topics: Adult; Anemia, Macrocytic; Female; Humans; Ileitis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Bacteria; Biopsy; Bone Marrow Examination; Erythrocyte Count; Female; Folic Acid; Hemoglobins; Humans; Intestinal Absorption; Intestine, Small; Jejunum; Male; Oxytetracycline; Remission, Spontaneous; Reticulocytes; Sprue, Tropical; Sulfaguanidine; Sulfonamides; Vitamin B 12; Xylose

Topics: Adolescent; Anemia, Macrocytic; Bone Marrow Examination; Female; Gastric Juice; Humans; Hydrochloric Acid; Infant; Intrinsic Factor; Kidney Function Tests; Malabsorption Syndromes; Male; Proteinuria; Schilling Test; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Antibodies; Antibody Formation; Cobalt Isotopes; Electrophoresis; Gels; Humans; Immunoelectrophoresis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Humans; Scotland; Vitamin B 12

Topics: Adult; Aged; Anemia, Macrocytic; Aneuploidy; Bone Marrow; Bone Marrow Cells; Chromosome Aberrations; Chromosome Disorders; Chromosomes, Human, 1-3; Chromosomes, Human, 13-15; Chromosomes, Human, 16-18; Chromosomes, Human, 19-20; Chromosomes, Human, 21-22 and Y; Chromosomes, Human, 4-5; Chromosomes, Human, 6-12 and X; Female; Humans; Karyotyping; Lymphocytes; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

A series of megaloblastic anemia attacks that occurred in a 25-year-old woman are discussed. These attacks occurred during pregnancy, and during and after use of oral contraceptives. The serum folic acid concentration during the attacks was around 2.3 mcg/ml, and other values were normal. After treatment with Vitamin-B12 and folic acid, the blood composition normalized. The anemia reccurred later without use of oral contraceptives; the pH in the duodenum was alkaline. The absorption of folic acid in the monoglutinate form was reduced and in the polyglutinate form had almost stopped. The patient may have an idiopathic selective folic acid absorption which was triggered by pregnancy and the use of oral contraceptives.

Topics: Absorption; Adult; Anemia, Macrocytic; Contraceptives, Oral; Duodenum; Female; Folic Acid; Humans; Hydrogen-Ion Concentration; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Asparaginase; Erythrocytes, Abnormal; Erythropoiesis; Female; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Blood Transfusion; Child; Female; Folic Acid; Humans; Intellectual Disability; Phenytoin; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Diet, Vegetarian; Ethnicity; Female; Folic Acid Deficiency; Glutens; Hemoglobins; Humans; India; London; Malabsorption Syndromes; Male; Middle Aged; Nutrition Disorders; Sprue, Tropical; United Kingdom; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow; Cobalt Isotopes; Deoxyuridine; Female; Folic Acid; Hemoglobins; Humans; In Vitro Techniques; Infant; Infant, Newborn; Methods; Orotic Acid; Phosphates; Thymidine; Vitamin B 12

Topics: Agranulocytosis; Anemia, Aplastic; Anemia, Macrocytic; Bone Marrow; Chronic Disease; Folic Acid; Humans; Leukemia, Myeloid; Leukocyte Count; Leukocytes; Muramidase; Myeloproliferative Disorders; Neutrophils; Polycythemia Vera; Protein Binding; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Autopsy; Female; Hominidae; Intestines; Liver; Lung; Lymph Nodes; Myocardium; Spleen; Stomach; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Bone Marrow; Bone Marrow Cells; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hookworm Infections; Humans; Malabsorption Syndromes; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Age Factors; Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Erythrocytes; Female; Folic Acid; Hemoglobins; Humans; Iron; Male; Sex Factors; Vitamin B 12; Wales

Topics: Adolescent; Anemia, Macrocytic; Anticonvulsants; Antitubercular Agents; Calcium; Celiac Disease; Child; Contraceptives, Oral; Drug-Related Side Effects and Adverse Reactions; Female; Folic Acid; Folic Acid Deficiency; Humans; Iatrogenic Disease; Male; Middle Aged; Neomycin; Nutrition Disorders; Osteomalacia; Pyridoxine; Rickets; Vitamin B 12

Topics: Alkaline Phosphatase; Anemia, Macrocytic; Hemoglobinometry; Leukocytes; Schilling Test; Vitamin B 12

Topics: Achlorhydria; Anemia, Macrocytic; Anemia, Pernicious; Autoantibodies; Cobalt Isotopes; Folic Acid Deficiency; Gastric Juice; Humans; Intrinsic Factor; Radioimmunoassay; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Erythrocyte Count; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Injections, Intravenous; Iron; Pregnancy; Pregnancy Complications, Hematologic; Reticulocytes; Urinary Tract Infections; Vitamin B 12

Topics: Acrylates; Adolescent; Adult; Aged; Aminosalicylic Acids; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Antitubercular Agents; Erythropoiesis; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Imidazoles; Iron; Isoniazid; Male; Middle Aged; Streptomycin; Tuberculosis; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Costs and Cost Analysis; Drug Prescriptions; England; Herpes Zoster; Humans; Multiple Sclerosis; Statistics as Topic; Vitamin B 12; Wales

Topics: Aged; Anemia, Macrocytic; Brain Chemistry; Erythrocytes; Humans; Male; Mucous Membrane; Neurologic Manifestations; Vitamin B 12

Topics: Anemia, Macrocytic; Biopsy; Folic Acid; Folic Acid Deficiency; Humans; Intestine, Small; Male; Middle Aged; Skin; Skin Manifestations; Vitamin B 12

The diagnostic value of the serum folate assay has been assessed in 90 patients, each of whom had a macrocytic anaemia and a low serum vitamin B(12) level. Twenty-nine (32%) patients were found to have anaemia due primarily to folate deficiency. The cause of the low serum vitamin B(12) levels is uncertain in the 22 (25%) patients with normal or borderline vitamin B(12) absorption. The effect of folic acid therapy was studied in four of these patients, and in each case the serum vitamin B(12) rose slowly to a normal level. The serum folate was low in only four (7.5%) of the 54 patients with pernicious anaemia, and the levels rose to normal on treatment with vitamin B(12) alone. A high serum folate occurred in eight (15%) pernicious anaemia patients. A normal serum folate indicated the diagnosis of pernicious anaemia or megaloblastic anaemia following partial gastrectomy. However, a normal serum folate and a very low vitamin B(12) level was found in two patients with idiopathic steatorrhoea. It is concluded that the serum folate assay is a valuable routine test in patients who have a macrocytic anaemia and low serum vitamin B(12). A low folate level makes the diagnosis of pernicious anaemia unlikely and is a strong indication for full investigation of small intestinal function.

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Postgastrectomy Syndromes; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Atrophy; Biopsy; Bone Marrow Cells; Child; Cobalt Isotopes; Diarrhea; Edema; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunum; Liver Diseases; Malabsorption Syndromes; Male; Middle Aged; Protein Deficiency; Serum Albumin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Avitaminosis; Folic Acid; Folic Acid Deficiency; Humans; Middle Aged; Vitamin B 12

Topics: Administration, Oral; Adolescent; Adult; Anemia, Macrocytic; Diet, Vegetarian; Female; Folic Acid; Hemoglobins; Humans; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anemia, Macrocytic; Anemia, Pernicious; Diet; Female; Folic Acid Deficiency; Humans; Intrinsic Factor; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Agammaglobulinemia; Agranulocytosis; Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Antineoplastic Agents; Bone Marrow Diseases; Elliptocytosis, Hereditary; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Myeloproliferative Disorders; Polycythemia Vera; Pregnancy; Primary Myelofibrosis; Spherocytosis, Hereditary; Thalassemia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Humans; Latex; Leukocytes; Microspheres; Phagocytosis; Skin Window Technique; Vitamin B 12

Topics: Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Anemia, Hypochromic; Anemia, Macrocytic; Antibodies; Cell Survival; Cobalt Isotopes; Diagnosis, Differential; Erythrocytes; Feces; Female; Folic Acid; Gastric Juice; Hematologic Diseases; Hemorrhage; Humans; Intrinsic Factor; Iron; Iron Isotopes; Plasma Volume; Radioimmunoassay; Radioisotope Dilution Technique; Radioisotopes; Radionuclide Imaging; Schilling Test; Spleen; Vitamin B 12; Whole-Body Counting

Topics: Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Biopsy; Bone and Bones; Calcium; Celiac Disease; Disability Evaluation; Dumping Syndrome; Female; Folic Acid Deficiency; Follow-Up Studies; Gastric Mucosa; Gastritis; Humans; Lactose Intolerance; Male; Middle Aged; Nutrition Disorders; Postgastrectomy Syndromes; Vitamin B 12

Topics: Achlorhydria; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Antibodies; Cestode Infections; Cobalt Isotopes; Female; Gastric Juice; Humans; Intrinsic Factor; Male; Methods; Middle Aged; Schilling Test; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Duodenal Ulcer; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Jejunum; Male; Peptic Ulcer; Postgastrectomy Syndromes; Stomach Ulcer; Vagotomy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Bone Marrow Examination; Euglena; Fluorometry; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Hydrocortisone; Infant; Lactobacillus; Male; Melanocyte-Stimulating Hormones; Middle Aged; Pigmentation Disorders; Radioimmunoassay; Sprue, Tropical; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Biological Assay; Euglena; Female; Folic Acid; Humans; Lactobacillus; Male; Vitamin B 12

Topics: Adrenal Cortex Hormones; Androstanes; Anemia, Aplastic; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Ascorbic Acid; Blood Transfusion; Humans; Iron; Iron-Dextran Complex; Ketones; Splenectomy; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Ascorbic Acid Deficiency; Contraceptives, Oral; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Gastric Juice; Humans; Intrinsic Factor; Nutritional Requirements; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Erythrocytes; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Ethnicity; Female; Folic Acid; Humans; India; London; Male; Middle Aged; Vitamin B 12

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anabolic Agents; Anemia, Aplastic; Anemia, Hypochromic; Anemia, Macrocytic; Female; Humans; Iron; Male; Middle Aged; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anti-Bacterial Agents; Depression, Chemical; Diet; Female; Folic Acid; Folic Acid Deficiency; Homes for the Aged; Humans; Male; Middle Aged; Sulfonamides; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Calcium; Duodenal Ulcer; Erythropoietin; Hemoglobinometry; Humans; Iron; Leukocyte Count; Male; Phosphorus Isotopes; Polycythemia Vera; Postgastrectomy Syndromes; Uric Acid; Vitamin B 12

Topics: Adult; Alcoholism; Anemia, Macrocytic; Bone Marrow; Bone Marrow Examination; Deoxyuridine; DNA; Erythrocytes; Female; Folic Acid; Folic Acid Antagonists; Humans; Liver Cirrhosis; Pregnancy; Thymine; Triamterene; Tritium; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Calcium; Carotenoids; Celiac Disease; Diarrhea; Edema; Emaciation; Feces; Female; Glutens; Hematocrit; Humans; Immunoglobulins; Intestinal Mucosa; Male; Middle Aged; Pancreatin; Phosphorus; Potassium; Pregnancy; Pregnancy Complications, Hematologic; Prothrombin Time; Serum Albumin; Tetany; Thrombophlebitis; Vitamin B 12; Xylose

Topics: Age Factors; Anemia, Macrocytic; Child; Child, Preschool; Diet; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Blood Cells; Bone Marrow Cells; Child; Child, Preschool; Deficiency Diseases; Female; Folic Acid; Humans; Infant; Iron; Male; Socioeconomic Factors; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Bilirubin; Blood Cell Count; Blood Glucose; Blood Platelets; Blood Proteins; Blood Sedimentation; Cholesterol; Echinococcosis, Hepatic; Erythrocyte Count; Female; Humans; Iron; Leukocyte Count; Liver Cirrhosis; Male; Middle Aged; Prothrombin; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Chromosomes; Culture Techniques; Deoxyuridine; DNA; Folic Acid; Folic Acid Deficiency; Humans; Lectins; Lymphocyte Activation; Lymphocytes; Thymidine; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Addisonian pernicious anaemia is believed to be very rare in Arabs. Three cases are reported. Two were Jordanians of Palestinian origin and one an Egyptian. All had the typical peripheral macrocytosis, a frankly megaloblastic bone marrow, and a Schilling test result in the range of pernicious anaemia. All three improved remarkably on vitamin B(12) therapy and have maintained a normal haemoglobin level. There was no evidence of gastric carcinoma in any of these cases.

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Bone Marrow Diseases; Ethnicity; Female; Humans; Kuwait; Male; Schilling Test; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Arthritis, Rheumatoid; Female; Gastric Juice; Humans; Middle Aged; Sjogren's Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Cobalt Isotopes; Feces; Folic Acid; Gastritis; Humans; In Vitro Techniques; Male; Vitamin B 12

Topics: Achlorhydria; Adult; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Blood Cell Count; Female; Folic Acid; Gastric Acidity Determination; Hematocrit; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Thalassemia; Urine; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Transfusion; Bone Marrow; Bone Marrow Cells; Chromosome Aberrations; Humans; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Antibody Formation; Autoantibodies; Autoimmune Diseases; Cell Migration Inhibition; Gastric Juice; Humans; Intestinal Absorption; Intrinsic Factor; Nutritional Requirements; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Anemia, Macrocytic; Female; Humans; Hydroxocobalamin; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Bacteria; Bacteriological Techniques; Bacteroides; Clostridium; Cobalt Isotopes; Enterobacteriaceae; Folic Acid; Humans; India; Intestinal Absorption; Intestinal Mucosa; Intestine, Small; Intubation, Gastrointestinal; Lactobacillus; Lipid Metabolism; Male; Middle Aged; Sprue, Tropical; Staphylococcus; Streptococcus; Tetracycline; Vitamin B 12; Water; Xylose

Topics: Aged; Alcoholism; Anemia, Macrocytic; Biopsy; Blood Cell Count; Fatty Liver; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Humans; Liver; Liver Cirrhosis; Liver Function Tests; Vitamin B 12

Topics: Absorption; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Animals; Biological Assay; Centrifugation; Cobalt Isotopes; Dialysis; Gastrectomy; Gastric Juice; Guinea Pigs; Heating; Histamine; Humans; In Vitro Techniques; Intestinal Mucosa; Intrinsic Factor; Male; Middle Aged; Pepsin A; Proteins; Vitamin B 12

Topics: Anemia, Macrocytic; Celiac Disease; Diverticulum; Duodenum; Humans; Intestinal Diseases; Jejunum; Male; Middle Aged; Spinal Cord Diseases; Tetracycline; Vitamin B 12

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Cobalt Isotopes; Female; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Male; Middle Aged; Vitamin B 12

Topics: Adult; Anemia, Hypochromic; Anemia, Macrocytic; Blood Transfusion; Bone Marrow Examination; Erythrocyte Count; Erythropoiesis; Female; Hematocrit; Hemoglobinometry; Humans; Iron; Nutrition Disorders; Nutritional Requirements; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Age Factors; Aged; Anemia, Macrocytic; Depression; Folic Acid; Folic Acid Deficiency; Gastrectomy; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Macrocytic; Anemia, Pernicious; Anemia, Sickle Cell; Celiac Disease; Cell Nucleus; Cheek; Epithelium; Fatty Liver; Female; Humans; Malabsorption Syndromes; Male; Microscopy; Middle Aged; Mouth Mucosa; Pregnancy; Pregnancy Complications, Hematologic; Thalassemia; Vitamin B 12

Topics: Anemia, Macrocytic; Child; Child, Preschool; Female; Folic Acid; Humans; Infant; Male; Vitamin B 12

Topics: Abruptio Placentae; Adult; Anemia, Macrocytic; Biological Assay; Bone Marrow Examination; Erythrocyte Count; Erythrocytes, Abnormal; Euglena; Female; FIGLU Test; Folic Acid Deficiency; Humans; Lactobacillus; Leukocyte Count; Maternal Mortality; Methods; Neutrophils; Pregnancy; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anorexia Nervosa; Bone Marrow Examination; Child; Female; Folic Acid; Folic Acid Deficiency; Histamine; Humans; Male; Mass Screening; Mental Disorders; Middle Aged; Neurocognitive Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Acetates; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Animals; Blood Cell Count; Creatine; Erythrocytes; Erythropoiesis; Female; Fructose-Bisphosphate Aldolase; Hemoglobinometry; Humans; Male; Rabbits; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Breast Feeding; Diet, Vegetarian; Folic Acid; Humans; Infant; Iron; Male; Milk, Human; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Child; Child, Preschool; Female; Hair; Humans; Infant; Infant, Newborn; Intellectual Disability; Male; Pigmentation Disorders; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Cholesterol; Diet Therapy; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Lipoproteins; Male; Mathematics; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Three patients are described, and they provide further evidence that deficiency of folic acid and vitamin B(12) may sometimes affect small intestinal function. Malabsorption of both xylose and vitamin B(12) returned to normal in one patient after treatment of a megaloblastic anaemia due to dietary deficiency of folic acid. Impaired absorption of vitamin B(12) was corrected by vitamin B(12) therapy in the other two patients. The initial cause of the vitamin B(12) deficiency in one patient was not apparent, but she was taking Gynovlar 21, which may have been an aetiological factor. In the third patient the small intestinal defect was secondary to pernicious anaemia, and in a group of 98 other patients with pernicious anaemia intrinsic factor did not improve vitamin B(12) absorption in six, and only partially corrected absorption in 30. The significance of these observations is discussed.

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Contraceptives, Oral; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestine, Small; Intrinsic Factor; Malabsorption Syndromes; Vitamin B 12; Vitamin B 12 Deficiency; Xylose

Topics: Adult; Age Factors; Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Blood Proteins; Chronic Disease; Female; Folic Acid; Hematocrit; Hemoglobinometry; Humans; Iron; Male; Middle Aged; Protein Deficiency; Pyridoxine; Serum Albumin; Serum Globulins; Sex Factors; Thiamine; Vitamin B 12; Vitamins

Topics: Anemia, Macrocytic; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Dietary Fats; Folic Acid; Hominidae; Nutritional Requirements; Reticulocytes; Vitamin B 12

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Autoradiography; Bone Marrow; Bone Marrow Cells; DNA; Erythrocytes; Female; Folic Acid; Histocytochemistry; Humans; Malabsorption Syndromes; Male; Middle Aged; Spectrophotometry; Tritium; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Humans; Isoenzymes; L-Lactate Dehydrogenase; Vitamin B 12

Topics: Administration, Oral; Aged; Anemia, Macrocytic; Bronchial Neoplasms; Carcinoma, Squamous Cell; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intramuscular; Male; Vitamin B 12

Topics: Amino Acids; Anemia, Macrocytic; Bone Marrow Examination; Child; Deafness; Diabetes Complications; DNA; Female; Folic Acid; Humans; Renal Aminoacidurias; Thiamine; Vitamin B 12; Vitamins

Topics: Adult; Anemia, Macrocytic; Anemia, Pernicious; Autoantibodies; Blood Cell Count; Diagnosis, Differential; Diphyllobothriasis; Female; Humans; Intrinsic Factor; Malabsorption Syndromes; Male; Middle Aged; Schilling Test; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Biotransformation; Female; Humans; Male; Malonates; Methane; Middle Aged; Postgastrectomy Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Animals; Bile; Biliary Tract Diseases; Cobalt Isotopes; Dogs; Feces; Intestinal Absorption; Liver; Rats; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Cell Count; Blood Platelets; Diet; Erythrocytes; Folic Acid; Hemoglobinometry; Humans; Leukocytes; Reticulocytes; Sprue, Tropical; Time Factors; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Bone Marrow Examination; Child; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Infant; Leukopenia; Malabsorption Syndromes; Male; Pregnancy; Thrombocytopenia; Uganda; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow Cells; Bone Marrow Examination; Child, Preschool; Deficiency Diseases; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Vitamin B 12

Topics: Albuminuria; Anemia, Macrocytic; Body Height; Body Weight; Child, Preschool; Female; Humans; Intestinal Absorption; Proteinuria; Schilling Test; Thrombocytopenia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Acetazolamide; Adult; Anemia, Macrocytic; Epilepsy; Female; Folic Acid; Humans; Male; Middle Aged; Phenobarbital; Phenytoin; Primidone; Psychophysiologic Disorders; Thiazines; Vitamin B 12

Topics: Acetates; Anemia, Macrocytic; Carbonic Anhydrases; Cellulose; Electrophoresis; Erythrocytes; Humans; Isoenzymes; Methods; Staining and Labeling; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Celiac Disease; Diverticulum; Erythrocyte Count; Female; Hematocrit; Hemoglobinometry; Humans; Intestinal Absorption; Intestine, Small; Jejunum; Leukocyte Count; Malabsorption Syndromes; Male; Neomycin; Radiography; Reticulocytes; Tetracycline; Vitamin B 12

Topics: Anemia, Macrocytic; Bone Marrow Examination; Child, Preschool; Chromosome Aberrations; Female; Folic Acid; Humans; Infant; Karyotyping; Male; Vitamin B 12

Topics: Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Bone Marrow Examination; Cestode Infections; Erythrocytes; Female; Hematocrit; Hemoglobinometry; Humans; Hyperthyroidism; Hypothyroidism; Iron; Kidney Failure, Chronic; Leukocyte Count; Male; Middle Aged; Neoplasms; Pregnancy; Transferases; Vitamin B 12

Topics: Achlorhydria; Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Black People; Cobalt Isotopes; Female; Folic Acid Deficiency; Humans; Intrinsic Factor; Male; Middle Aged; Radiometry; Vitamin B 12; Vitamin B 12 Deficiency; White People

Topics: Anemia, Macrocytic; Blood Cell Count; Blood Protein Electrophoresis; Blood Transfusion; Breast Feeding; Female; Folic Acid; Humans; Infant; Male; Nutrition Disorders; Penicillins; Pigmentation Disorders; Sri Lanka; Streptomycin; Thalassemia; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Autoradiography; Bone Marrow Cells; Densitometry; DNA; Erythrocytes, Abnormal; Erythropoiesis; Hemoglobinometry; Humans; In Vitro Techniques; Leucine; Methods; Protein Biosynthesis; RNA; Thymidine; Tritium; Uridine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Diet; Female; FIGLU Test; Folic Acid; Hematocrit; Hemoglobinometry; Humans; Pregnancy; Pregnancy Complications, Hematologic; Prenatal Care; South Africa; Vitamin B 12

Topics: Adult; Aged; Anemia; Anemia, Macrocytic; Anemia, Pernicious; Biopsy; Blood Cell Count; Bone Marrow Examination; Carotenoids; Cholesterol; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Hematocrit; Hemoglobinometry; Humans; Hypothyroidism; Iron; Jejunum; Kidney Function Tests; Liver Function Tests; Middle Aged; Myxedema; Thyroid Function Tests; Thyroidectomy; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intravenous; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Bone Marrow Examination; Child; Crohn Disease; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Male; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Infections; Lyases; Malabsorption Syndromes; Male; Postoperative Complications; Skin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Chromosome Aberrations; Chromosome Disorders; Folic Acid Deficiency; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Bone Marrow; Bone Marrow Cells; Deoxyuridine; DNA; Female; Folic Acid; Folic Acid Deficiency; Humans; In Vitro Techniques; Methionine; Methotrexate; Thymine; Tritium; Uridine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Body Height; Body Weight; Chromosome Aberrations; Chromosome Disorders; Diet Therapy; Female; Genes, Recessive; Growth; Humans; Infant; Infant, Newborn; Intellectual Disability; Intelligence Tests; Intrinsic Factor; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Anemia, Pernicious; Female; Humans; Ligases; Male; Malonates; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Anti-Bacterial Agents; Bile Acids and Salts; Biopsy; Chronic Disease; Cobalt Isotopes; Fats; Feces; Folic Acid; Hemoglobinometry; Humans; Indican; Intestinal Diseases; Intestinal Secretions; Intestine, Small; Jejunum; Malabsorption Syndromes; Sprue, Tropical; Time Factors; Vitamin B 12; Xylose

Topics: Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Anemia, Sideroblastic; Cell Membrane; Child; Erythrocytes; Erythropoiesis; Female; Hemagglutination; Humans; Isoantibodies; Isoantigens; Male; Middle Aged; Umbilical Cord; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Biological Assay; Erythrocytes; Euglena; Folic Acid Deficiency; Humans; Plasma; Polycythemia; Vitamin B 12

Topics: Adult; Aged; Anemia, Macrocytic; Chromosome Aberrations; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Histones; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Blood Protein Electrophoresis; Bone Marrow Examination; Child, Preschool; Deficiency Diseases; Folic Acid; Hematocrit; Hemoglobinometry; Humans; India; Infant; Iron; Protein Deficiency; Reticulocytes; Vitamin B 12; Vitamin E

Topics: Adolescent; Adult; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Bilirubin; Blood Cell Count; Blood Proteins; Child; Child, Preschool; Cholesterol; Diet Therapy; Female; Folic Acid; Folic Acid Deficiency; Health Surveys; Hematocrit; Hemoglobinometry; Humans; Intestinal Diseases, Parasitic; Iron; Male; Pregnancy; Pregnancy Complications, Hematologic; Trinidad and Tobago; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Folic Acid; Folic Acid Deficiency; Gastrectomy; Histidine; Humans; Iron; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Erythrocyte Count; Female; Humans; Injections, Intramuscular; Iron; Male; Middle Aged; Propionates; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Bone Marrow; Hematopoiesis; Humans; Vitamin B 12

Topics: Achlorhydria; Anemia, Macrocytic; Gastrins; Histamine; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Radioimmunoassay; Stimulation, Chemical; Time Factors; Vitamin B 12

Topics: Age Factors; Anemia, Macrocytic; Anticonvulsants; Brain; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Humans; Intellectual Disability; Male; Mental Disorders; Peripheral Nerves; Phenobarbital; Phenytoin; Primidone; Psychotic Disorders; Sex Factors; Spinal Cord; Vitamin B 12

Topics: Anemia, Macrocytic; Humans; Prednisone; Vitamin B 12

Topics: Anemia, Macrocytic; Child, Preschool; Folic Acid; Humans; Liver; Liver Cirrhosis; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Urea Nitrogen; Bone Marrow Examination; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Humans; Kidney Failure, Chronic; Renal Dialysis; Uremia; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Erythrocyte Count; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Infant, Newborn; New Guinea; Pregnancy; Pregnancy Complications, Hematologic; Reticulocytes; Vitamin B 12

Topics: Adult; Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow Examination; Female; FIGLU Test; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Cycloserine; Female; Folic Acid Deficiency; Humans; Isoniazid; Male; Middle Aged; Tuberculosis, Pulmonary; Vitamin B 12

Topics: Anemia, Macrocytic; Diet, Vegetarian; Female; Gastric Juice; Gastric Mucosa; Humans; Jejunum; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Agranulocytosis; Anemia, Macrocytic; Anemia, Pernicious; Clinical Enzyme Tests; Folic Acid Deficiency; Humans; Muramidase; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Blood Protein Electrophoresis; Chick Embryo; Diet; Female; Folic Acid Deficiency; Hemoglobins; Humans; Phenylalanine; Pregnancy; Pregnancy Complications, Hematologic; Pteridines; Reticulocytes; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Asian People; Feces; Female; Folic Acid; Hemoglobinometry; Humans; Lipids; Pregnancy; Pregnancy Complications, Hematologic; Reticulocytes; Singapore; Sprue, Tropical; Vitamin B 12; White People

Topics: Aged; Anemia, Macrocytic; Anemia, Pernicious; Cobalt Isotopes; Female; Gastrectomy; Histamine; Humans; Intestinal Absorption; Intrinsic Factor; Male; Middle Aged; Radiometry; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anemia, Sickle Cell; Blood Proteins; Carbon Isotopes; Female; Folic Acid; Humans; In Vitro Techniques; Male; Middle Aged; Reticulocytes; Ribosomes; Schilling Test; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Transfusion; Child; Child, Preschool; Cobalt Isotopes; Folic Acid; Humans; Leukopenia; Malabsorption Syndromes; Male; Myelitis; Proteinuria; Schilling Test; Thrombocytopenia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Diagnosis, Differential; Folic Acid; Hemoglobins; Hookworm Infections; Humans; Intestinal Absorption; Megakaryocytes; Protein Deficiency; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Bone Marrow Examination; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Postgastrectomy Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Blood Transfusion; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Erythropoiesis; Hemoglobins; Humans; Infant; Intellectual Disability; Milk, Human; Pigmentation Disorders; Reticulocytes; Vitamin B 12

Topics: Adult; Aminosalicylic Acids; Anemia, Macrocytic; Female; Folic Acid; Folic Acid Deficiency; Humans; Isoniazid; Male; Middle Aged; Tuberculosis, Pulmonary; Vitamin B 12

Topics: Achlorhydria; Adult; Aged; Anemia, Macrocytic; Biopsy; Female; Humans; Liver; Male; Middle Aged; Postgastrectomy Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Folic Acid; Humans; Vitamin B 12

Topics: Adult; Aged; Anemia, Macrocytic; Biological Assay; Blood Proteins; Bone Marrow Examination; Cerebral Ventriculography; Child; Child, Preschool; Dietary Fats; Electroencephalography; Erythrocytes; Female; FIGLU Test; Folic Acid; Humans; Hydrolases; Infant; Intellectual Disability; Intestinal Absorption; Liver; Liver Function Tests; Male; Metabolism, Inborn Errors; Middle Aged; Oxidoreductases; Transferases; Vitamin B 12; Xylose

Topics: Aged; Anemia, Macrocytic; Biological Assay; Cobalt Isotopes; Dementia; Electroencephalography; Female; FIGLU Test; Fluorescent Antibody Technique; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Humans; Intestinal Absorption; Vitamin B 12; Xylose

Topics: Anemia, Macrocytic; Diagnosis, Differential; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Psychotic Disorders; Spinal Cord Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Bone Marrow; Bone Marrow Cells; DNA; Erythropoiesis; Female; Hematopoiesis; Humans; Injections, Intramuscular; Male; Middle Aged; Nucleotides; Tetrahydrofolate Dehydrogenase; Thymidine; Thymidine Kinase; Tritium; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Child, Preschool; Female; Humans; Intestinal Absorption; Male; Proteinuria; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Intermediate megaloblastic changes occurred in six (19%) of 32 patients with multiple myeloma and trivial megaloblastic changes in a further ten (31%). Folate deficiency was the predominant cause of these changes and in at least two patients was sufficiently severe to contribute to anaemia. Folate deficiency appeared to be due to exćess folate utilization by the tumour and was related to the amount of paraprotein produced daily. Five of the 32 patients had subnormal serum B(12) levels. Reduction in the serum B(12) level was related to the reduction in the normal circulating immunoglobulins and occurred despite normal B(12) absorption. Possible explanations for this finding are discussed.

Topics: Adult; Aged; Anemia, Macrocytic; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Multiple Myeloma; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Folic Acid Deficiency; Humans; Injections, Intramuscular; Injections, Intravenous; Iron; Splenectomy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Africa, Southern; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Asia; Australia; Europe; Female; Folic Acid; Gestational Age; Humans; Iron; Israel; Mexico; Pregnancy; Pregnancy Complications, Hematologic; United States; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Epilepsy; Female; Folic Acid; Humans; Intestinal Absorption; Phenobarbital; Phenytoin; Primidone; Vitamin B 12

Topics: Anemia, Macrocytic; Blood Chemical Analysis; FIGLU Test; Folic Acid; Humans; Leukemia; Lymphatic Diseases; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Multiple Myeloma; Neoplasms; Urine; Vitamin B 12

Topics: Anemia, Macrocytic; Ascorbic Acid; Child, Preschool; Female; Folic Acid; Humans; Infant; Iron; Male; Protein-Energy Malnutrition; Vitamin B 12; Vitamin E

The incidence of megaloblastic anaemia in pregnancy and the puerperium in north Staffordshire has steadily declined as a result of prophylaxis with folic acid. In the presence of advanced folic acid deficiency and with a florid megaloblastic marrow, the anaemia is usually severe, but in many patients the disease is relatively mild and the degree of anaemia is determined more by blood loss or associated iron deficiency than by the megaloblastosis. Microscopic examination of marrow films is still the most reliable method of diagnosis, although estimation of the labile serum folate has produced a 95% correlation with the marrow findings. There are three main factors which operate in the pathogenesis of megaloblastic anaemia in pregnancy and the puerperium. First, the maternal stores of folic acid are used up by the growing foetus, and this process is accelerated in multiple pregnancies, after haemorrhage, or in women with haemolytic anaemia. Secondly, an insufficient intake of folic acid, due to poor diet in pregnancy, plays a part in many cases. The third, and possibly the most important, factor is an absorption defect. Folic acid absorption is usually impaired in established cases, and this can still be demonstrated years later in a majority of patients, when they are neither pregnant nor anaemic. More than 20% of all cases also show abnormal fat absorption. An inherited defect in folic acid absorption may also explain why certain women appear to be constitutionally predisposed to megaloblastic anaemia of pregnancy and the puerperium, as shown by the abnormal blood group distribution in these patients and by the tendency of megaloblastic anaemia to recur not only in subsequent pregnancies, but, as in six of our cases, following other kinds of stress. The significance of commonly associated conditions like pre-eclampsia and infection is still incompletely understood. Although the treatment of megaloblastic anaemia is simple and effective, the main emphasis should be placed on prophylaxis by administering folic acid to all pregnant women.

Topics: Adult; Anemia, Hemolytic; Anemia, Macrocytic; Blood; Blood Group Antigens; Female; Folic Acid; Hemorrhage; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Vitamin B 12

Topics: Anemia, Macrocytic; Arthritis, Rheumatoid; Blood; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Oxyphenbutazone; Phenylbutazone; Vitamin B 12

Topics: Achlorhydria; Aged; Anemia, Macrocytic; Antibodies; Chemical Precipitation; Cobalt Isotopes; Electrophoresis; Gastric Juice; Humans; In Vitro Techniques; Intestinal Absorption; Intrinsic Factor; Jejunum; Male; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Biological Assay; Blood Transfusion; Bone Marrow; Diet, Vegetarian; Folic Acid; Histamine; Humans; Intrinsic Factor; Iron; Jejunum; Male; Vitamin B 12

Topics: Anemia, Macrocytic; Animals; Folic Acid; Hemoglobinometry; Intestinal Absorption; Iron; Liver; Male; Postgastrectomy Syndromes; Rats; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Humans; Male; Middle Aged; Pigmentation Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Anemia, Pernicious; Female; Humans; Hydroxybutyrate Dehydrogenase; L-Lactate Dehydrogenase; Liver Extracts; Vitamin B 12

Topics: Anemia, Macrocytic; Bone Marrow Cells; Folic Acid; Humans; Infant; Protein Deficiency; Vitamin B 12

Topics: Anemia, Macrocytic; Bone Marrow Examination; Celiac Disease; Dumping Syndrome; Folic Acid Deficiency; Humans; Male; Middle Aged; Radiography; Tetracycline; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Blood Transfusion; Folic Acid; Hemoglobins; Humans; Vitamin B 12

Non-anemic women attending a public antenatal clinic were given, daily, a multivitamin tablet containing 78 mg. of elemental iron. The follow-up studies included an analysis of their diets. A total of 311 patients were included, of which one group received a supplement of 0.5 mg. folic acid and 0.005 mg. vitamin B(12). The incidence of megaloblastic bone marrow change in the unsupplemented group was 26% and of low blood folates approximately 50%. The incidence of megaloblastic changes was sharply reduced in the supplemented group and the blood folates were elevated to supranormal levels, indicating that the dose of folic acid used may have been above the minimal requirement. Formiminoglutamic acid (FIGLU) excretion could not be correlated with other parameters of folate deficiency. Neutrophil lobe counts did not relate to megaloblastic changes or low folate levels unless there was more than 5% hypersegmentation. The dietary intake was suboptimal in total calories, iron and food folate.

Topics: Anemia, Macrocytic; Blood Proteins; Bone Marrow Examination; Diet; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hematocrit; Humans; Iron; Plasma Volume; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B Complex

The results of the measurement of vitamin B(12) absorption by counting the radioactivity of 5 ml. serum obtained eight to 10 hours after the ingestion of an oral dose of 0.5 mug. vitamin B(12) labelled with 0.5 muc. (57)Co are compared with those obtained with the urinary excretion (Schilling) test. Inadequate urine collection and impaired renal function were responsible for low results in the Schilling test in four of the 12 control subjects, and an incomplete urine collection in four patients with pernicious anaemia could have led to doubt about the validity of the low result. The measurement of serum radioactivity for 1,000 seconds gave conclusive results, the range in the patients with malabsorption of vitamin B(12) being between 0 and 24 counts per minute, and in the control subjects and other patients with megaloblastic anaemia between 28 and 64 counts per minute. The highest serum radioactivity level in a patient with pernicious anaemia was 19 counts per minute. Serum counting is simpler than the Schilling test and may be done alone when the patient's renal function is known to be poor, when urine collection is expected to be unreliable, or when the flushing dose of vitamin B(12) should be avoided. Otherwise there is an advantage in doing both tests together for confirmation.

Topics: Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Cobalt Isotopes; Intestinal Absorption; Postgastrectomy Syndromes; Radiometry; Vitamin B 12

Topics: Anemia, Macrocytic; Child, Preschool; Female; Humans; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Female; Humans; In Vitro Techniques; Infant; Milk, Human; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Macrocytic; Blood; Bone Marrow; FIGLU Test; Folic Acid; Humans; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Bone Marrow Diseases; Child, Preschool; Folic Acid; Hemoglobins; Humans; India; Infant; Iron; Kwashiorkor; Seasons; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Antitubercular Agents; Blood; Bone Marrow Examination; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Tuberculosis; Tuberculosis, Lymph Node; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Renal; Vitamin B 12

Topics: Adult; Aged; Amino Acids; Anemia, Macrocytic; Anemia, Pernicious; Aspartic Acid; Blood; Female; Humans; Male; Middle Aged; Nucleic Acids; Valine; Vitamin B 12

Topics: Absorption; Acute Kidney Injury; Anemia, Macrocytic; Blood; Carbachol; Cobalt Isotopes; Humans; In Vitro Techniques; Injections; Radiometry; Solutions; Urine; Vitamin B 12

Topics: Absorption; Anemia, Macrocytic; Blood; Cobalt Isotopes; Feces; Humans; In Vitro Techniques; Solutions; Urine; Vitamin B 12

Topics: Anemia, Macrocytic; Blood; Female; Folic Acid; Humans; In Vitro Techniques; Intestinal Absorption; Middle Aged; Sprue, Tropical; Tetracycline; Vitamin B 12

Topics: Anemia, Macrocytic; Child; Child, Preschool; Female; Humans; Infant; Male; Metabolism, Inborn Errors; Vitamin B 12

Topics: Anemia, Macrocytic; Humans; Infant; Malabsorption Syndromes; Male; Peptide Hydrolases; Proteinuria; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Animals; Erythrocytes; Erythropoiesis; Female; Fetus; Iron; Pregnancy; Pregnancy, Animal; Rats; Transferrin; Vitamin B 12

Topics: Anemia, Macrocytic; Diagnosis, Differential; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Blood; Folic Acid; Folic Acid Deficiency; Hematinics; Humans; Malabsorption Syndromes; Nutrition Disorders; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Drug Therapy; Hematinics; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Examination; Child; Fluids and Secretions; Folic Acid; Humans; Infant; Metabolism, Inborn Errors; Nucleosides; Orotic Acid; Prognosis; Purine-Pyrimidine Metabolism, Inborn Errors; Pyridoxine; Thyroxine; Uridine; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Bone Marrow Examination; Classification; Clinical Laboratory Techniques; Drug Therapy; Folic Acid; Humans; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Black People; Diagnosis; Diverticulum; Drug Therapy; Duodenal Diseases; Geriatrics; Humans; Jejunum; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biological Assay; Bone Marrow Examination; Clinical Enzyme Tests; Erythropoiesis; Folic Acid; Folic Acid Deficiency; Humans; Hydroxybutyrate Dehydrogenase; L-Lactate Dehydrogenase; Lactobacillus; Vitamin B 12

Folic acid deficiency with the picture of a megaloblastic bone marrow may develop in haemolytic anaemia, and, on the other hand, both vitamin B(12) and folic acid deficiency may produce signs of haemolysis. As the correct interpretation of a positive antiglobulin reaction associated with megaloblastic erythropoiesis is particularly important, the effect of deficiency of vitamin B(12) and folic acid on the results of the test was investigated in 32 patients with vitamin B(12) or folic acid deficiency and a positive antiglobulin reaction was obtained in ten. There was no correlation between the result of the test and the degree of anaemia, and there was no significant difference between the incidence of positive results associated with deficiency of vitamin B(12) or folic acid. In determining the significance of a positive result, the time interval before agglutination occurs is sometimes of greater value than the strength of the reaction or the result of the gamma globulin neutralization test.

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Antibodies, Anti-Idiotypic; Coombs Test; Folic Acid; Folic Acid Deficiency; gamma-Globulins; Hemagglutination Inhibition Tests; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Blood Chemical Analysis; Bronchi; Bronchial Neoplasms; Carcinoma, Squamous Cell; Celiac Disease; Feces; Fluids and Secretions; Folic Acid; Folic Acid Deficiency; Humans; Hypokalemia; Hypoproteinemia; Jejunum; Lipid Metabolism; Malabsorption Syndromes; Pathology; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Cobalt Isotopes; Drug Therapy; Fluids and Secretions; Humans; Hydroxocobalamin; Metabolism; Urine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Bone Marrow Examination; Diet; Drug Therapy; Female; Fetal Death; Folic Acid; Liver; Maternal Mortality; Nigeria; Pathology; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Seasons; Statistics as Topic; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Avitaminosis; Blood Cell Count; Bone Marrow Examination; Child; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutamates; Glutamic Acid; Histidine; Humans; Imidazoles; Kwashiorkor; Metabolism; Urine; Urocanic Acid; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Drug Therapy; Folic Acid; Hemochromatosis; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Blood Chemical Analysis; Bone Diseases; Calcium; Calcium, Dietary; Celiac Disease; Drug Therapy; Folic Acid; Gastrectomy; Geriatrics; Humans; Iron; Malabsorption Syndromes; Postgastrectomy Syndromes; Postoperative Care; Postoperative Complications; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Brazil; Child; Deficiency Diseases; Diet; Diet Therapy; Dietary Proteins; Drug Therapy; Erythrocyte Count; Folic Acid; Glycine max; Hemoglobinometry; Humans; Infant; Milk; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Blood Chemical Analysis; Clinical Laboratory Techniques; Cobalt Isotopes; Gastrectomy; Glutamates; Hematinics; Histamine; Humans; Intestinal Absorption; Intrinsic Factor; Lactobacillus; Pharmacology; Radiometry; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Chemical Analysis; Diet; Diet Therapy; Drug Therapy; FIGLU Test; Folic Acid; Folic Acid Deficiency; Geriatrics; Hematinics; Hemochromatosis; Humans; Liver Cirrhosis; Liver Function Tests; Metabolism; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biological Assay; Blood; Diet; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Histidine; Humans; Iron; Lactobacillus; Metabolism; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Urine; Vitamin B 12; Vitamin B Complex

Topics: Alcoholism; Anemia; Anemia, Macrocytic; Ankyrins; Blood Transfusion; Drug Therapy; Folic Acid; Folic Acid Deficiency; Hematinics; Humans; Injections; Spherocytosis, Hereditary; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Diverticulum; Drug Therapy; Duodenal Diseases; Humans; Intestines; Metronidazole; Tetracycline; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Corrinoids; Folic Acid; Folic Acid Deficiency; Humans; Radioisotopes; Thymidine; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Blood; Blood Cell Count; Bone Marrow Examination; Child; Egypt; Hematocrit; Hemoglobins; Humans; Infant; Kwashiorkor; Protein Deficiency; Vitamin B 12; Vitamin E

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Megaloblastic; Blood; Drug Therapy; Folic Acid; Hematopoiesis; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Calcium; Calcium, Dietary; Diet; Diet Therapy; Dietary Fats; Drug Therapy; Fats; Humans; Ileum; Intestines; Jejunum; Magnesium; Malabsorption Syndromes; Postoperative Complications; Surgical Procedures, Operative; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Topics: Anemia; Anemia, Macrocytic; Animals; Diet; Dietary Proteins; Erythrocytes; Female; Hemoglobins; Humans; Israel; Poultry; Pregnancy; Statistics as Topic; Vitamin B 12

Topics: Anemia, Hypochromic; Anemia, Macrocytic; Blood Cell Count; Bone Marrow; Child; Chromatography; Chromosomes; Female; Folic Acid; Humans; Leukemia; Neutrophils; Peroxidases; Porphyrins; Staining and Labeling; Succinate Dehydrogenase; Uracil; Uracil Nucleotides; Urine; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Ascorbic Acid; Blood; Diet Therapy; England; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Male; Middle Aged; Nutrition Surveys; Vitamin B 12; Vitamins

Topics: Adult; Anemia, Macrocytic; Bone Marrow Examination; Erythrocyte Count; Female; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Injections, Intramuscular; Iron; Reticulocytes; Vitamin B 12

Topics: Aged; Anemia, Hypochromic; Anemia, Macrocytic; Gastrectomy; Humans; Intrinsic Factor; Iron; Male; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Ascorbic Acid; Blood; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Iron; Lactobacillus; Leuconostoc; Vitamin B 12

Topics: Anemia, Macrocytic; Cobalt Isotopes; Feces; Folic Acid; Gastrointestinal Diseases; Hematologic Diseases; Humans; Intestinal Absorption; Urine; Vitamin B 12

The urinary excretion of injected cyanocobalamin was studied in 30 previously untreated vitamin B(12)-deficient patients by measuring the urinary radioactivity after repeated injections of (58)Co vitamin B(12). The dose range used was 54 to 30,000 mug., each patient receiving the same dose at each injection. The results show that there is no constant trend to the excretion of greater or smaller proportions of the amount injected. It is also shown that there is a wide variation in the amounts excreted by each individual and between individual patients and that the capacity of the tissues to retain injected cyanocobalamin is very great, the amounts retained often being greatly in excess of the normal body stores. The excretion of radioactivity after parenteral infections of (58)Co vitamin B(12) was usually complete within 24 hours but exceptions to this were seen. The significance and value of the results is discussed.

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Cobalt Isotopes; Humans; Injections, Intravenous; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Female; Folic Acid; Humans; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Vitamin B 12

Topics: Adolescent; Anemia; Anemia, Macrocytic; Blood Sedimentation; Bone Marrow Examination; Erythrocyte Count; Hemoglobinometry; Humans; Liver; Liver Extracts; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anticonvulsants; Biological Assay; Blood Chemical Analysis; Enterococcus faecalis; Epilepsy; Folic Acid; Folic Acid Antagonists; Humans; Lactobacillus; Phenobarbital; Phenytoin; Primidone; Toxicology; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Blood Chemical Analysis; Bone Marrow Examination; Erythropoiesis; Female; Folic Acid; Humans; India; Pregnancy; Vitamin B 12

Topics: Absorption; Anemia; Anemia, Macrocytic; Animals; Celiac Disease; Cobalt Isotopes; Gastric Juice; Haplorhini; Ileum; India; Kwashiorkor; Macaca mulatta; Protein Deficiency; Research; Sprue, Tropical; Vitamin B 12

Topics: Adenosine Triphosphate; Adrenocorticotropic Hormone; Aminocaproates; Aminocaproic Acid; Anabolic Agents; Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Blood Transfusion; Bone Marrow Transplantation; Hematologic Diseases; Hematology; Hemophilia A; Humans; Iron; Leukemia; Methandrostenolone; Methyltestosterone; Nandrolone; Purpura; Purpura, Thrombocytopenic; Steroids; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Ascorbic Acid; Blood Cell Count; Bone Marrow Examination; Erythropoiesis; Folic Acid; Geriatrics; Glutamates; Hematocrit; Hemoglobinometry; Humans; Iron; Liver Diseases; Liver Extracts; Phosphatidylethanolamines; Pyridoxine; Reticulocytes; Sulfobromophthalein; Urine; Vitamin B 12

Topics: Alcoholism; Anemia; Anemia, Macrocytic; Anorexia Nervosa; Ascorbic Acid; Avitaminosis; Celiac Disease; Deficiency Diseases; Diet; Diet Therapy; Female; Folic Acid; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications; Sprue, Tropical; United Kingdom; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin K; Vitamins; Vomiting

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Barbiturates; Biological Assay; Blood Chemical Analysis; Folic Acid; Folic Acid Deficiency; Geriatrics; Glutamates; Toxicology; Urine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Female; Folic Acid; Humans; Iron; Leukocytosis; Pelger-Huet Anomaly; Polycythemia Vera; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Thalassemia; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Corrinoids; Gastrectomy; Hematinics; Vitamin B 12

Topics: Anemia; Anemia, Hemolytic; Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Blood; Celiac Disease; Clinical Laboratory Techniques; Epilepsy; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Glutamates; Humans; Lymphoma; Lymphoma, Non-Hodgkin; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Urine; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Humans; Hypothyroidism; Iron; Myxedema; Thyroid Hormones; Vitamin B 12

Topics: Aminosalicylic Acid; Aminosalicylic Acids; Anemia; Anemia, Macrocytic; Cobalt Isotopes; Corrinoids; Humans; Schilling Test; Toxicology; Urine; Vitamin B 12; Vitamin B 12 Deficiency

There is a significant fall in the serum folic acid level during pregnancy, reaching its lowest level at term. This is most pronounced in twin pregnancies. A similar but less spectacular fall occurs in the vitamin B(12) concentration. In megaloblastic anaemia both folic acid and vitamin B(12) levels are lower than in other pregnant women. The degree of megaloblastic change in the bone marrow, as measured by the type and number of megaloblasts, is reflected in the vitamin levels, cases with florid megaloblastosis showing the most marked depression of vitamin B(12) and folic acid activity. Although there is a significant difference in the mean folic acid levels between megaloblastic and normoblastic pregnant women, a considerable overlap exists between individual values in the two groups. When the labile folic-acid factor is determined separately the test becomes much more specific. In the present series, all cases of megaloblastic anaemia yielded labile-factor levels below 1.0 mmug. per ml., while a similar value was encountered in only one of 35 normal pregnancies. In five women with megaloblastic anaemia the vitamin B(12) concentration was less than 100 mumug. per ml. but rose to normal levels on folic acid therapy alone.

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Biological Assay; Blood; Bone Marrow; Bone Marrow Examination; Classification; Euglena; Female; Folic Acid; Humans; Lactobacillus; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Twins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aging; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Avitaminosis; Biomedical Research; Calcium; Enzymes; Erythrocytes; Erythrocytes, Abnormal; Folic Acid; Geriatrics; Spherocytes; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Celiac Disease; Classification; Folic Acid; Folic Acid Deficiency; Humans; Japan; Metabolism; Physiology; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Avitaminosis; Biological Assay; Biopsy; Blood; Bone Marrow Examination; Cerebrospinal Fluid; Clinical Laboratory Techniques; Diet; Folic Acid; Folic Acid Deficiency; Jejunum; Lactobacillus; Metabolism; Pathology; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Avitaminosis; Clinical Laboratory Techniques; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Geriatrics; Glutamates; Humans; Maternal-Fetal Exchange; Metabolism; Pregnancy; Primary Myelofibrosis; Urine; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Carbachol; Celiac Disease; Cobalt Isotopes; Colonic Neoplasms; Duodenal Ulcer; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Gastric Juice; Histamine; Humans; Insulin; Intrinsic Factor; Male; Pharmacology; Physiology; Sprue, Tropical; Vitamin B 12

Topics: Adolescent; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Breast Neoplasms; Bronchopneumonia; Child; Deficiency Diseases; Female; Folic Acid; Gastroenterology; Geriatrics; Hemorrhage; Humans; Liver Diseases; Liver Extracts; Multiple Myeloma; Nucleosides; Postpartum Hemorrhage; Postpartum Period; Rheumatic Fever; Sepsis; Toxicology; Virus Diseases; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Bone and Bones; Calcium; Folic Acid; Folic Acid Deficiency; Gastrectomy; Humans; Statistics as Topic; Vitamin B 12

Topics: Absorption; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Blood Chemical Analysis; Bone Marrow Examination; Cobalt Isotopes; Folic Acid; Folic Acid Deficiency; Gastrectomy; Humans; Postgastrectomy Syndromes; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Blood Proteins; Copper; Drug Therapy; Female; Hematocrit; Hemoglobinometry; Humans; Iron; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Shock, Hemorrhagic; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Folic Acid; Humans; Liver Extracts; Vitamin B 12

Topics: Absorption; Anemia; Anemia, Macrocytic; Animals; Bacteria; Cobalt Isotopes; Dietary Fats; Dogs; Feces; Hematinics; Jejunum; Metabolism; Pathology; Research; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Heart Diseases; Hematinics; Humans; Iron; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Celiac Disease; Deficiency Diseases; Diagnosis; Female; Folic Acid; Humans; Intrinsic Factor; Malabsorption Syndromes; Physiology; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anticonvulsants; Celiac Disease; Female; FIGLU Test; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Formiminoglutamic Acid; Histidine; Humans; Intestinal Diseases; Intestine, Small; Intestines; Liver Diseases; Metabolic Diseases; Neoplasms; Postoperative Complications; Pregnancy; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Brain Diseases; Cysticercosis; Drug Therapy; Epilepsy; Folic Acid; Humans; Iatrogenic Disease; Phenobarbital; Phenytoin; Primidone; Spinal Cord; Toxicology; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Platelet Disorders; Drug Therapy; Epilepsy; Female; Folic Acid; Hemorrhage; Humans; Phenobarbital; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Primidone; Thrombocytopenia; Toxicology; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Antineoplastic Agents; Blood Chemical Analysis; Child; Folic Acid; Humans; Hydroxyurea; Toxicology; Urea; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biopsy; Blood Chemical Analysis; Bone Marrow Examination; Erythropoiesis; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutamic Acid; Hemoglobins; Histidine; Lactobacillus; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Urine; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Diverticulum; Drug Therapy; Escherichia coli Infections; Geriatrics; Humans; Intestinal Absorption; Intestine, Small; Intestines; Tetracycline; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Anemia, Macrocytic; Blood Platelets; Bone Marrow Cells; Drug Therapy; Epoetin Alfa; Erythropoietin; FIGLU Test; Folic Acid; Folic Acid Deficiency; Glutamates; Hemoglobins; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Iron; Iron-Dextran Complex; Megakaryocytes; Reticulocytes; Thrombocytopenia; Thrombocytosis; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Biological Assay; Blood Chemical Analysis; Bone Marrow Examination; Celiac Disease; Cobalt Isotopes; Euglena; Feces; Fluids and Secretions; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Lactobacillus; Singapore; Sprue, Tropical; Statistics as Topic; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Black People; Blood Chemical Analysis; Bone Marrow; Deficiency Diseases; Drug Therapy; Folic Acid; Folic Acid Deficiency; Gastric Juice; Gastric Mucosa; Glutamates; Hematopoiesis; Humans; Hydrochloric Acid; Intrinsic Factor; Pathology; Pharmacology; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Celiac Disease; Diverticulum; Drug Therapy; Geriatrics; Humans; Intestinal Diseases; Intestine, Small; Intestines; Pain; Steatorrhea; Tetracycline; Toxicology; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Vitamin B 12; Vitamin B 12 Deficiency; Yeast, Dried

Topics: Anemia; Anemia, Macrocytic; Anti-Bacterial Agents; Celiac Disease; Diet; Drug Therapy; Folic Acid; Hematinics; Humans; Intestinal Absorption; Jejunum; Metabolism; Sprue, Tropical; Tetracycline; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Blood Cell Count; Blood Protein Electrophoresis; Calcium; Drug Therapy; Geriatrics; Humans; Immunoelectrophoresis; Iron; Multiple Myeloma; Osteoporosis; Plasmacytoma; Pneumonia; Vitamin B 12; Vitamin B 12 Deficiency; Waldenstrom Macroglobulinemia

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Folic Acid; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Carbon; Folic Acid; Humans; Metabolism; Methionine; Nucleosides; Tetrahydrofolates; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Blood Cell Count; Deficiency Diseases; Drug Therapy; Female; Folic Acid; Folic Acid Deficiency; Humans; Intrinsic Factor; Malabsorption Syndromes; Metabolism; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Ascorbic Acid; Folic Acid; Humans; Metabolism; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Drug Therapy; Humans; Polycythemia Vera; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Blood; Blood Cell Count; Geriatrics; Glutamates; Iron; Neutrophils; Pyrimethamine; Toxicology; Urine; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Animals; Cobalt Isotopes; Digestive System Surgical Procedures; Dogs; Gastrectomy; Hematinics; Humans; Hydrochloric Acid; Intestinal Absorption; Pylorus; Research; Schilling Test; Surgical Procedures, Operative; Urine; Vagotomy; Vitamin B 12; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Drug Therapy; Gastrectomy; Humans; Intrinsic Factor; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Sideroblastic; Ascorbic Acid; Child; Folic Acid; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Hematinics; Humans; Incidence; Vitamin B 12

The importance of deficiency of the folic acid group of compounds (folates) in the pathogenesis of nutritional anaemias is receiving increasing recognition. There is evidence that the megaloblastic anaemias, due to either vitamin B(12) or folate deficiency, may be the cause of widespread morbidity in malnourished populations. It was therefore considered timely to review certain aspects of the role of folates in megaloblastic anaemia, with special reference to the dietary intake in relation to human requirements, and the recognition of folate deficiency in man.

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Folic Acid Deficiency; Humans; Male; Vitamin A Deficiency; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Biotin; Humans; Intestines; Intrinsic Factor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Corrinoids; Diagnosis, Differential; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Corrinoids; Folic Acid; Humans; Prednisolone; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Corrinoids; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Corrinoids; Humans; Vitamin B 12; Vitamins

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Folic Acid; Histidine; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Diet, Vegetarian; Humans; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Ascorbic Acid; Ascorbic Acid Deficiency; Folic Acid; Humans; Vitamin B 12; Vitamin B 12 Deficiency

A study of the reproducibility and reliability of the Schilling test in patients with primary malabsorptive disease and after partial gastrectomy is reported. The value of the test was assessed by repeated tests in each patient. Consistently normal or abnormal results were obtained in only one of the seven patients with primary malabsorptive disease and in only two of the eight patients who had undergone partial gastrectomy. From these results it is concluded that the result of a single test may be of little clinical value. Assessment of the results suggests that the mean value for a series of Schilling tests may give some indication of value clinically about the capacity to absorb radioactive vitamin B(12) at the time of the tests at least in patients who have undergone partial gastrectomy. The significance of the findings is discussed, particularly in relation to the aetiology of post-gastrectomy megaloblastic anaemia.

Topics: Anemia, Macrocytic; Celiac Disease; Cobalt Isotopes; Gastrectomy; Humans; Postgastrectomy Syndromes; Reproducibility of Results; Schilling Test; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Bile; Feces; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Diabetic Neuropathies; Hematinics; Humans; Hydrogen Cyanide; Hydroxocobalamin; Neuritis; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Folic Acid; Hematinics; Hematologic Tests; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Ankyrins; Folic Acid; Humans; Spherocytosis, Hereditary; Splenectomy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Folic Acid; Geriatrics; Hemoglobinometry; Humans; Reticulocytes; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia; Anemia, Macrocytic; Child; Cobalt Isotopes; Genetics, Medical; Hematinics; Humans; Infant; Metabolism; Prednisone; Proteinuria; Tetracycline; Urine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Blood Chemical Analysis; Diagnosis; Folic Acid; Humans; L-Lactate Dehydrogenase; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Humans; Hydroxocobalamin; Meningoencephalitis; Neuritis; Pellagra; Postgastrectomy Syndromes; Spinal Cord; Spinal Cord Diseases; Spinal Cord Neoplasms; Vitamin B 12; Vitamin B Complex

Topics: Anemia, Macrocytic; Anemia, Pernicious; Gastrectomy; Gastroenterostomy; Humans; Postgastrectomy Syndromes; Spinal Cord; Subacute Combined Degeneration; Vitamin B 12

Topics: Amobarbital; Anemia, Macrocytic; Anemia, Megaloblastic; Anticonvulsants; Barbiturates; Epilepsy; Folic Acid; Humans; Metabolism; Phenobarbital; Phenytoin; Primidone; Toxicology; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Corrinoids; Enterobacter aerogenes; Euglena; Humans; Lactobacillus; Pharmacology; Pigments, Biological; Reticulocytes; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Humans; Pelger-Huet Anomaly; Sex Chromatin; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Black People; Ethnology; Humans; India; South Africa; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow Examination; Fatty Liver; Folic Acid; Gastrectomy; Hemochromatosis; Hemosiderosis; Humans; Iron; Liver Cirrhosis; Vitamin B 12; Vitamin B Deficiency

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Humans; Hypothyroidism; Postgastrectomy Syndromes; Protein Deficiency; Thyroid Hormones; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Asian People; Blood Chemical Analysis; Bone Marrow Examination; Dietary Carbohydrates; Dietary Proteins; Folic Acid; Folic Acid Deficiency; Leucovorin; Lipids; Myanmar; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Duodenal Ulcer; Gastrectomy; Humans; Pathology; Peptic Ulcer; Postgastrectomy Syndromes; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Cobalt Isotopes; Humans; Intrinsic Factor; Schilling Test; Urine; Vitamin B 12

Topics: Anemia, Macrocytic; Anemia, Pernicious; Cobalt Isotopes; Gastritis; Humans; Intestinal Absorption; Isotope Labeling; Malabsorption Syndromes; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Corrinoids; Folic Acid; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Corrinoids; Folic Acid; Liver Extracts; Vitamin B 12

A method for the measurement of serum folic acid activity is described, which is a modification of previous methods. The material in serum with activity for L. casei is made up of a stable and a labile component. The amount of stable component in normal subjects and patients with megaloblastic anaemia is similar. The amount of labile component varies. In patients with folic acid deficiency none is present; in normal subjects it constitutes between 65 and 94% of the total serum L. casei activity. The labile component appears to be an index of folic acid metabolism, and the assay of total serum L. casei activity is therefore a valuable method for differentiating patients requiring treatment with folic acid from normal subjects and patients with primary vitamin B(12) deficiency. Normal subjects had serum folic acid levels from 5.9 to 21.0 mmug./ml. (mean 9.9 mmug./ml. +/- 0.3 mmug./ml. S.E.). In patients with megaloblastic anaemia requiring treatment with folic acid, other than megaloblastic anaemia of pregnancy, the levels were less than 4.0 mmug./ml. Patients with uncomplicated pernicious anaemia had levels from 6.0 to 27.0 mmug./ml. (mean 16.6 mmug./ml. +/- 1.1 mmug./ml. S.E.). The mean level in this group was higher than in normal subjects, and the highest levels of all were found in patients with subacute combined degeneration of the cord with minimal anaemia (range 14.4 to 36.8 mmug./ml.; mean 24.8 mmug./ml. +/- 2.4 mmug./ml. S.E.). The L. casei activity of the labile component is lost during autoclaving or storage at -20 degrees C. This loss can be prevented during autoclaving by using adequate amounts of ascorbic acid in the phosphate buffer used to dilute the serum for assay and by adding ascorbic acid to serum that is to be stored. Moreover, the activity lost during the storage of serum not protected by ascorbic acid could be restored, for periods up to three months, by adding ascorbic acid to this serum before assay.

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Biological Assay; Female; Folic Acid; Folic Acid Deficiency; Hematologic Tests; Humans; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Macrocytic; Diverticulum; Humans; Intestine, Small; Intestines; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Bone Marrow; Humans; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Diverticulum; Humans; Intestine, Small; Intestines; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Folic Acid; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Corrinoids; Diagnosis, Differential; Humans; Liver; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Body Fluids; Disease; Humans; Peripheral Nerves; Radioisotopes; Steatorrhea; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Humans; Liver; Vitamin B 12

Topics: Anemia, Macrocytic; Erythrocytes; Humans; Liver Cirrhosis; Liver Diseases; Liver Extracts; Spleen; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Corrinoids; Folic Acid; Hematologic Tests; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Hematinics; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Blood; Corrinoids; Folic Acid; Hematinics; Humans; Iron; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Animals; Folic Acid; Folic Acid Deficiency; Gastric Juice; Humans; Intrinsic Factor; Rats; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Gastrectomy; Humans; Intrinsic Factor; Stomach; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Corrinoids; Humans; Liver; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Hematinics; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Disease; Humans; Intestinal Diseases; Intestine, Small; Intestines; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Hematinics; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Animals; Diet; Feces; Folic Acid; Haplorhini; Hematinics; Humans; Liver; Scurvy; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Animals; Folic Acid; Swine; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Hematinics; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Folic Acid; Hematinics; Humans; Leucovorin; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Child; Folic Acid; Humans; Nutritional Status; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Corrinoids; Folic Acid; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Child; Humans; Infant; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Celiac Disease; Folic Acid; Hematinics; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Corrinoids; Folic Acid; Hematinics; Humans; Linitis Plastica; Stomach Diseases; Stomach Neoplasms; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Sideroblastic; Genetic Diseases, X-Linked; Humans; Vitamin B 12

Topics: Anemia, Macrocytic; Folic Acid; Hematinics; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Animals; Cats; Folic Acid Deficiency; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Humans; Pregnancy; Pregnancy Complications; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Humans; Pregnancy; Vitamin B 12

Topics: Administration, Oral; Anemia; Anemia, Macrocytic; Celiac Disease; Hematinics; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Animals; Liver; Liver Extracts; Rabbits; Saponins; Silver Compounds; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Corrinoids; Erythrocytes; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Corrinoids; Female; Humans; Postpartum Period; Pregnancy; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Humans; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Folic Acid; Humans; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Female; Folic Acid; Humans; Postpartum Period; Pregnancy; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Hematinics; Mouth; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Animals; Corrinoids; Folic Acid; Glutamates; Liver; Liver Extracts; Rats; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Anemia, Macrocytic; Corrinoids; Humans; Liver; Liver Extracts; Mucous Membrane; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Folic Acid; Humans; Sprue, Tropical; Thymine; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Corrinoids; Hematinics; Humans; Obstetrics; Vitamin B 12; Vitamin B Complex; Vitamins