vitamin-b-12 and Heart-Failure

Vitamin B deficiency causes cardiac hypertrophy, reduced cardiac contractility, and arrhythmias.The purpose of this study is to perform a network meta-analysis of randomized controlled trials of vitamin B supplements in a group of 150 patients who meet the eligibility criteria.The study also aims to describe the effect of synthetic multivitamins (pyridoxine, folic acid, and cyanocobalamin) on the laboratory findings reflecting the severity of chronic heart failure (cholesterol, glucose, and fibrinogen).. The experiment involved a group of people (150 individuals) diagnosed with chronic heart failure with reduced left ventricular ejection fraction. The study compared serum levels of B vitamins measured after the therapy and at baseline. The second part of the study focused on the assessment of the laboratory findings reflecting the severity of cardiovascular pathology and indicating an increased risk of vascular catastrophes.. Clinical trials among patients diagnosed with chronic heart failure showed that the intake of synthetic forms of pyridoxine, folic acid, and cyanocobalamin slightly increases systolic, diastolic and central venous pressure while decreasing the heart rate and increasing LVEF. Thiamine acts as a vasodilator. It reduces the cardiac afterload and improves heart function.. The results obtained can be useful in terms of improving the comprehensive treatment strategy for chronic heart failure and further investigation of the effects produced by the intake of B vitamins.

Topics: Chronic Disease; Folic Acid; Heart Failure; Humans; Pyridoxine; Stroke Volume; Ventricular Function, Left; Vitamin B 12; Vitamin B Complex

Nutritional factors such as magnesium, folic acid, vitamins B12 and B6, L-arginine, and polyunsaturated fatty acids (PUFAs) appear to be significantly beneficial for patients with coronary artery disease (CAD), and in the prevention and arresting the progression of HF and cardiac arrhythmias. Additionally, ingestion of adequate amounts of protein and maintaining normal concentrations of plasma albumin seem to be essential for these patients. These nutrients closely interact with the metabolism of L-arginine-nitric oxide (NO) system, essential fatty acids, and eicosanoids such that beneficial products such as NO, prostaglandin E1, prostacyclin, prostaglandin I3, lipoxins, resolvins, and protectins are generated and synthesis of proinflammatory cytokines is suppressed that results in platelet anti-aggregation, vasodilation, angiogenesis, and prevention of CAD, cardiac arrhythmias, and stabilization of HF. This implies that individuals at high risk for CAD, cardiac arrhythmias, and HF and those who have these diseases need to be screened for plasma levels of magnesium, folic acid, vitamins B12 and B6, L-arginine, NO, various PUFAs, lipoxin A4, resolvins, protectins, asymmetrical dimethylarginine (an endogenous inhibitor of NO), albumin, and various eicosanoids and cytokines and correct their abnormalities to restore normal physiology.

Topics: Alprostadil; Anti-Inflammatory Agents; Arginine; CD59 Antigens; Coronary Artery Disease; Diabetes Mellitus, Type 2; Epoprostenol; Fatty Acids, Essential; Fatty Acids, Unsaturated; Female; Folic Acid; Heart Failure; Humans; Hypertension; Lipoxins; Magnesium; Male; Middle Aged; Nitric Oxide; Nutritional Status; Serum Albumin; Vasodilation; Vitamin B 12; Vitamin B 6

Homocysteine is a sulfur amino acid whose metabolism stands at the intersection of 2 pathways: remethylation, which requires folic acid and B-12 coenzymes, and transsulfuration, which requires pyridoxal-5'-phosphate, the B-6 coenzyme. Data from several studies suggest that mild elevations of homocysteine in plasma are a risk factor for occlusive vascular disease. In the Framingham studies we have shown that plasma total homocysteine concentration is inversely related to the intake and plasma levels of folate and vitamin B-6 as well as vitamin B-12 plasma levels. Almost two-thirds of the prevalence of high homocysteine is attributable to low vitamin status or intake. Elevated homocysteine concentrations in plasma are a risk factor for prevalence of extracranial carotid artery stenosis of at least 25% in both men and women. Prospectively elevated plasma homocysteine is associated with increased total and CVD mortality, increased incidence of stroke, increased incidence of dementia and Alzheimer's disease, increased incidence of bone fracture, and higher prevalence of chronic heart failure. This multitude of relationships between elevated plasma total homocysteine and diseases that afflict the elderly point to the existence of a common denominator that may be responsible for these diseases. Whether this denominator is homocysteine itself or whether homocysteine is merely a marker remains to be determined.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Cardiovascular Diseases; Carotid Stenosis; Cohort Studies; Dementia; Diet; Female; Folic Acid; Fractures, Bone; Heart Failure; Homocysteine; Humans; Hyperhomocysteinemia; Male; Massachusetts; Middle Aged; Risk Factors; Stroke; Vascular Diseases; Vitamin B 12; Vitamin B 6

Moderate hyperhomocysteinemia (HHCY) is a risk factor for cardiovascular (CVD) and neurodegenerative diseases, osteoporotic fractures and complications during pregnancy. Elderly persons have a high prevalence of HHCY. Vitamin deficiency is by far the most common cause of HHCY. Retrospective and prospective studies emphasize a causal relationship between HHCY and the CVD risk. Some vitamin intervention trials, however, did not lower the risk of CVD. From power calculation one can conclude that these trials may not involve sufficient numbers of patients to assure statistically valid conclusions. Re-analysis of the VISP study (excluding renal failure and vitamin B12 status tampering factors), however, detected a 21% decrease in the risk of stroke. This number has been confirmed by results from the HOPE 2 vitamin intervention trial. Folic acid enrichment of grain products in the US and Canada has led to a significant decline of stroke mortality, since 1998 annually 12900 fewer stroke deaths in the US and 2800 fewer stroke deaths in Canada. Despite negative results from secondary prevention trials regarding the CVD risk reduction there is convincing evidence about the effectiveness of B-vitamin supplementation in lowering the stroke risk. The overall decline in stroke risk calculated in meta-analysis from prospective studies and found in intervention trials is around 20%. Additionally, HHCY was recently linked to the occurrence and severity of chronic heart failure. HHCY is also a risk factor for osteoporotic fractures and vitamin treatment lowered the fracture risk significantly. Furthermore, there is a correlation between HHCY and cognitive disorders or Alzheimer's disease. HHCY is a predictive parameter for the decline in cognitive function. Hypomethylation is among the central mechanisms through which HHCY acts cytotoxically. HHCY and low folate are causal factors for pregnancy complications. In addition to the recommended folate supplementation, vitamin B12 supplementation could further decrease pregnancy complications. Determination of homocysteine plasma concentration should be part of the individual risk profile, especially for elderly subjects who are at risk for CVD, neurodegenerative diseases or osteoporotic fractures.

Topics: Age Factors; DNA Methylation; Female; Folic Acid; Heart Failure; Humans; Hyperhomocysteinemia; Neurodegenerative Diseases; Osteoporosis; Pregnancy; Pregnancy Complications; Risk Factors; Vitamin B 12

Topics: Adenosine Triphosphatases; Adenosine Triphosphate; Amino Acids; Aortic Valve Stenosis; Cardiac Glycosides; Digitalis Glycosides; Diuretics; Heart Failure; Heart Ventricles; Hemodynamics; Humans; Hypertrophy; Methionine; Myosins; Nucleic Acids; Orotic Acid; Pantothenic Acid; Protein Biosynthesis; Protein Precursors; Stimulation, Chemical; Strophanthins; USSR; 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

Hematinic deficiency irrespective of anemia is not uncommon in patients with heart failure. We studied the prevalence, distribution, and etiology of anemia in patients with heart failure with reduced ejection fraction (HFrEF) and compared it with non-anemic patients.. Congestive heart failure (CHF) was diagnosed by modified Framingham criteria and ejection fraction (EF) <40%. Iron deficiency (ID) anemia was defined as serum ferritin level <100 ng/ml (absolute) or 100-300 ng/ml with transferrin saturation <20% (functional). Vitamin B12 and folate deficiency were defined as <200pg/ml and <4ng/ml respectively.. 688 patients with HFrEF were studied with an overall mean age of 57.2±13.8 years, and males outnumbering females (62.3% vs. 37.7%). Coronary artery disease (44.2%), dilated cardiomyopathy (46.8%), and valvular heart disease (6.7%) were major causes of CHF.Anemia was found in 63.9% of patients. Vit B12 deficiency, and folate deficiency were found in 107 (15.55%), and 54 (7.85%) subjects, respectively. Absolute ID was detected in 186 (42.27%) patients with anemia and 84 (33.87%) patients without anemia, while functional ID was present in 80 (18.18%) patients with anemia and 29 (11.69%) patients without anemia. Vitamin B12 deficiency was noted in 70 (15.9%) patients with anemia and 37 (14.9%) patients without anemia, while folate deficiency was noted in 31 (7.04%) patients with anemia and 23 (9.2%) patients without anemia. Hematinic deficiency among the study population was distributed equally among patients irrespective of EF, NYHA class, socioeconomic class diet pattern.. The study shows that hematinic deficiency was seen even in non-anemic patients irrespective of diet pattern. Supplementation could be a strong strategy to improve outcomes in these patients of heart failure irrespective of anemia and should be evaluated in prospective studies.

Topics: Adult; Aged; Anemia; Anemia, Iron-Deficiency; Female; Folic Acid; Heart Failure; Hematinics; Humans; Male; Middle Aged; Prospective Studies; Stroke Volume; Ventricular Dysfunction, Left; Vitamin B 12; Vitamin B 12 Deficiency

Iron deficiency is known to aggravate the prognosis of patients with heart failure. Iron has functions in the mitochondrial respiratory chain. In patients with reduced mitochondrial respiration, the mitochondrial ratio between the level of nicotinamide adenine dinucleotide and its reduced form decreases. Due to the mitochondrial-lysosomal interplay, decreased mitochondrial respiration also leads to inhibition of lysosomal hydrolysis. As a result, cobalamin and iron will be trapped in lysosomes. This will, even if iron and cobalamin have been consumed and absorbed in sufficient amounts, lead to their functional deficiencies.

Topics: Heart Failure; Homocysteine; Humans; Iron; Lysosomes; Methylmalonic Acid; Vitamin B 12

PGC-1α, a key regulator of energy metabolism, seems to be a relevant therapeutic target to rectify the energy deficit observed in heart failure (HF). Since our previous work has shown positive effects of cobalamin (Cb) on PGC-1α cascade, we investigate the protective role of Cb in pressure overload-induced myocardial dysfunction. Mice were fed with normal diet (ND) or with Cb and folate supplemented diet (SD) 3weeks before and 4weeks after transverse aortic constriction (TAC). At the end, left ventricle hypertrophy and drop of ejection fraction were significantly lower in SD mice than in ND mice. Alterations in mitochondrial oxidative capacity, fatty acid oxidation and mitochondrial biogenesis transcription cascade were markedly improved by SD. In SD-TAC mice, lower expression level of the acetyltransferase GCN5 and upregulation of the methyltransferase PRMT1 were associated with a lower protein acetylation and a higher protein methylation levels. This was accompanied by a sustained expression of genes involved in mitochondrial biogenesis transcription cascade (Tfam, Nrf2, Cox1 and Cox4) after TAC in SD mice, suggesting a preserved activation of PGC-1α; this could be at least partly due to corrected acetylation/methylation status of this co-activator. The beneficial effect of the treatment would not be due to an effect of Cb and folate on oxidative stress or on homocysteinemia, which were unchanged by SD. These results showed that Cb and folate could protect the failing heart by preserving energy status through maintenance of mitochondrial biogenesis. It reinforces the concept of a metabolic therapy of HF.

Topics: Animals; Biomarkers; Cells, Cultured; Dietary Supplements; Disease Models, Animal; Energy Metabolism; Folic Acid; Heart Failure; Hyperhomocysteinemia; Mice; Mitochondria, Heart; Models, Biological; Myocardial Contraction; Myocardium; Myocytes, Cardiac; Oxidation-Reduction; Oxidative Stress; Vitamin B 12

To determine the prevalence, clinical correlates and the effects on outcome of vitamin B12 and folic acid levels in patients with chronic heart failure (HF).. We studied an international pooled cohort comprising 610 patients with chronic HF. The main outcome measure was all-cause mortality.. Mean age of the patients was 68±12 years and median serum N-terminal prohormone brain natriuretic peptide level was 1801 pg/mL (IQR 705-4335). Thirteen per cent of the patients had an LVEF >45%. Vitamin B12 deficiency (serum level <200 pg/mL), folate deficiency (serum level <4.0 ng/mL) and iron deficiency (serum ferritin level <100 µg/L, or 100-299 µg/L with a transferrin saturation <20%) were present in 5%, 4% and 58% of the patients, respectively. No significant correlation between mean corpuscular volume and vitamin B12, folic acid or ferritin levels was observed. Lower folate levels were associated with an impaired health-related quality of life (p=0.029). During a median follow-up of 2.10 years (1.31-3.60 years), 254 subjects died. In multivariable proportional hazard models, vitamin B12 and folic acid levels were not associated with prognosis.. Vitamin B12 and folate deficiency are relatively rare in patients with chronic HF. Since no significant association was observed between mean corpuscular volume and neither vitamin B12 nor folic acid levels, this cellular index should be used with caution in the differential diagnosis of anaemia in patients with chronic HF. In contrast to iron deficiency, vitamin B12 and folic acid levels were not related to prognosis.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Biomarkers; Chronic Disease; Erythrocyte Indices; Europe; Female; Ferritins; Folic Acid Deficiency; Heart Failure; Humans; Iron; Kaplan-Meier Estimate; Linear Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prevalence; Proportional Hazards Models; Quality of Life; Risk Factors; Stroke Volume; Time Factors; Transferrin; Treatment Outcome; Ventricular Function, Left; Vitamin B 12; Vitamin B 12 Deficiency

Genome-wide association studies on components of the one-carbon metabolic pathway revealed that human vitamin B12 levels could be significantly influenced by variations in the fucosyltransferase 2 (FUT2), cubilin (CUBN), and transcobalamin-I (TCN1) genes. An altered vitamin B12 level is an important factor that disturbs the homeostasis of the folate metabolism pathway, which in turn can potentially lead to the development of congenital heart disease (CHD). Therefore, we investigated the association between the variants of vitamin B12-related genes and CHD in Han Chinese populations.. Six variants of the vitamin B12-related genes were selected for analysis in two independent case-control studies, with a total of 868 CHD patients and 931 controls. The variant rs11254363 of the CUBN gene was associated with a decreased risk of developing CHD in both the separate and combined case-control studies. Combined samples from the two cohorts had a significant decrease in CHD risk for the G allele (OR = 0.48, P = 1.7×10⁻⁵) and AG+GG genotypes (OR = 0.49, P = 4×10⁻⁵), compared with the wild-type A allele and AA genotype, respectively.. Considering the G allele of variant rs11254363 of the CUBN gene was associated with an increased level of circulating vitamin B12. This result suggested that the carriers of the G allele would benefit from the protection offered by the high vitamin B12 concentration during critical heart development stages. This finding shed light on the unexpected role of CUBN in CHD development and highlighted the interplay of diet, genetics, and human birth defects.

Topics: Alleles; Asian People; Case-Control Studies; Child; Child, Preschool; China; Female; Fucosyltransferases; Galactoside 2-alpha-L-fucosyltransferase; Genetic Markers; Genetics, Population; Genotype; Haplotypes; Heart Failure; Humans; Linkage Disequilibrium; Male; Polymorphism, Single Nucleotide; Receptors, Cell Surface; Risk; Transcobalamins; Vitamin B 12

A 90-year-old woman was referred and admitted to our hospital because of progressing dementia, decreased appetite, and general fatigue. Blood tests on admission disclosed: white cell count, 2,900 /mm(3); hemoglobin 5.6 g/dl; mean corpuscular volume; 139.7 microm(3). Based on the presence of pancytopenia, macrocytic anemia, and elevated lactate dehydrogenises, we suspected pernicious anemia. We administered vitamin B12, which improved the blood test results and the signs of dementia. Gastrointestinal tract examination showed type A gastritis. Tests for anti-intrinsic factor antibody and anti-gastric parietal cell antibody were positive, which help confirm a diagnosis of pernicious anemia. Pernicious anemia is an autoimmune disease common among those aged 50-60 years. Cases aged over 90 years are rare. However, the numbers of extremely elderly patients are expected to increase with the growth of the elderly population. Fortunately, pernicious anemia is easy to treat. We need to make an appropriate diagnosis of pernicious anemia in the oldest elderly patients.

Topics: Aged, 80 and over; Anemia, Pernicious; Dementia; Female; Gastritis; Heart Failure; Humans; Vitamin B 12

Topics: Anemia; Heart Failure; Humans; Iron, Dietary; Nutritional Status; Risk Assessment; Risk Factors; Vitamin B 12

Serum cobalamin (vitamin B12), bound to transcobalamin II, is taken up by the endothelium of the hepatic vasculature via a receptor-mediated membrane transport process. We hypothesized hepatic congestion is associated with elevated serum B12 without hepatocyte necrosis.. Serum B12, aspartate and alanine transaminases, alkaline phosphatase, bilirubin (Bili), and brain natriuretic peptide (BNP) were monitored at the time of admission in 91 hospitalized patients: (a) 38 with decompensated biventricular failure having systemic venous distention, tricuspid regurgitation (TR), and echocardiographic evidence of inferior vena cava dilation and moderate to marked TR; (b) 18 with acute left heart failure having a myocardial infarction, an ischemic cardiomyopathy, or hypertensive heart disease; and (c) 35 without clinical evidence of failure despite myocardial infarction, pericarditis, or atrial arrhythmia. Serum cobalamin (normal 180-600 pg/mL) was elevated with biventricular failure (861.4 +/- 53.0 pg/mL) compared with (P < 0.0001) left heart or no failure, where B12 remained normal. Serum aspartate, alanine, and alkaline phosphatase were normal in each group whereas Bili was increased (1.8 +/- 0.2 mg/dL; P < 0.05) with biventricular failure. Plasma BNP was elevated in each group.. Elevated cobalamin and Bili are respective biomarkers of hepatocellular dysfunction and cholestasis in patients having decompensated biventricular failure with systemic venous distention and TR without hepatocyte necrosis vis-à-vis left heart failure or in the absence of clinical failure. Elevated plasma BNP did not distinguish between the presence or absence of systemic venous congestion.

Topics: Adult; Aged; Female; Heart Failure; Humans; Liver; Male; Middle Aged; Natriuretic Peptide, Brain; Ventricular Dysfunction; Vitamin B 12; Vitamin B Complex; Young Adult

Total homocysteine (tHcy) has been linked to the severity of chronic heart failure (CHF). Elevated tHcy concentrations are mainly caused by folate and vitamin B-12 deficiencies.. We hypothesized that folate and vitamin B-12 deficiencies can explain the relation between tHcy and the severity of CHF.. We investigated 987 CHF patients. All subjects underwent a physical examination and blood sampling. Cardiac catheterization was performed in 929 patients and echocardiography in 460 patients. Serum tHcy, folate, vitamin B-12, and N-terminal pro-B-type natriuretic-peptide (NT-proBNP) were measured and renal and hepatic function were studied.. tHcy increased with increasing New York Heart Association (NYHA) classes of heart failure (P < 0.001) and correlated with the left ventricular ejection fraction (EF; r = -0.150, P < 0.001). Contrary to the hypothesis, vitamin B-12 (P < 0.001) increased with NYHA class (P < 0.001) and was negatively correlated with EF (r = -0.080, P = 0.015). Folate showed no relation with NYHA class or EF. Comparable results were obtained for NT-proBNP (tHcy: r = 0.27, P < 0.001; vitamin B-12: r = 0.091, P = 0.004; folate: r = -0.045, P = 0.169). The correlations between tHcy, EF, and NT-proBNP were significantly stronger in patients without coronary artery disease (CAD) than in those with CAD. Regression analysis showed that tHcy, but not B vitamins, is a strong predictor of EF and NT-proBNP.. This study showed that tHcy, but not folate and vitamin B-12, is related to clinical, echocardiographic, and laboratory variables of CHF, which indicates a relation between tHcy and the severity of CHF. This relation is stronger in patients without CAD. The lack of association of folate and the paradoxical relation of vitamin B-12 with CHF can possibly be explained by a disturbance in hepatic homeostasis.

Topics: Aged; Cardiac Catheterization; Echocardiography; Female; Folic Acid; Folic Acid Deficiency; Heart Failure; Homocysteine; Humans; Liver; Male; Middle Aged; Multivariate Analysis; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Anemia in chronic heart failure (CHF) is common, varying in prevalence between 14.4% and 55%, and is more frequent in patients with more severe heart failure. Patients with CHF who have anemia have a poorer quality of life, higher hospital admission rates, and reduced exercise tolerance. We explored the relation between hematinic levels and hemoglobin (Hb) levels and exercise tolerance in a group of patients with CHF.. We analyzed data from 173 patients with left ventricular systolic dysfunction (LVSD), 123 patients with symptoms of heart failure, but preserved left ventricular (LV) systolic function ("diastolic dysfunction"), and 58 control subjects of similar age. Each underwent echocardiography, a 6-minute walk test, and blood tests for renal function and Hb and hematinic levels (vitamin B12, iron, and folate). We classified patients as having no anemia (Hb level >12.5 g/dL), mild anemia (Hb level from 11.5-12.5 g/dL), or moderate anemia (Hb level <11.5 g/dL).. Of patients with LVSD, 16% had moderate anemia and 19% had mild anemia. Of patients with preserved LV function, 16% had moderate anemia and 17% had mild anemia. Four control subjects had a Hb level <12.5 g/dL. Of all patients, 6% were vitamin B12 deficient, 13% were iron deficient, and 8% were folate deficient. There was no difference between patients with LVSD and the diastolic dysfunction group. In patients with LVSDS, the average Hb level was lower in New York Heart Association class III than classes II and I. The distance walked in 6 minutes correlated with Hb level in both groups of patients with CHF (r = 0.29; P <.0001). Patients with anemia achieved a lower pVO2 (15.0 [2.3] vs 19.5 [4.4], P <.05). Peak oxygen consumption correlated with Hb level (r = 0.21, P <.05) in the patients, but not in the control subjects. In patients with anemia, the mean creatinine level was higher than in patients with a Hb level >12.5 g/dL, but there was no clear relationship with simple regression. Hematocrit level and mean corpuscular volume were not different in the patients with diastolic dysfunction, patients with LV dysfunction, or the control subjects. Hematocrit levels were not influenced by diuretic dose. Patients with anemia were not more likely to be hematinic deficient than patients without anemia.. Patients with symptoms and signs of CHF have a high prevalence of anemia (34%) whether they have LV dysfunction or diastolic dysfunction, but few patients have hematinic deficiency. Hemoglobin levels correlate with subjective and objective measures of severity and renal function.

Topics: Aged; Anemia; Anemia, Iron-Deficiency; Case-Control Studies; Chronic Disease; Creatinine; Exercise Test; Female; Ferritins; Folic Acid; Folic Acid Deficiency; Heart Failure; Humans; Iron; Male; Oxygen Consumption; Ventricular Dysfunction, Left; Vitamin B 12; Vitamin B 12 Deficiency

The skin often provides diagnostic clues to systemic disorders. Vitiligo is an acquired disease characterized by depigmentation of the skin due to destruction of melanocytes. Vitiligo may be an autoimmune disease and is associated with other disorders that may also arise due to autoimmune mechanisms. We present the unusual case of vitiligo associated with pernicious anemia in a patient who presented to the hospital because of hyperdynamic congestive heart failure.

Topics: Adult; Anemia, Pernicious; Benzothiadiazines; Digoxin; Diuretics; Female; Heart Failure; Humans; Sodium Chloride Symporter Inhibitors; Vitamin B 12; Vitiligo

Topics: Aged; Anemia, Pernicious; Angiography; Arteriovenous Fistula; Female; Heart Failure; Heart Murmurs; Humans; Hypertension, Renal; Nephrectomy; Renal Artery; Subtraction Technique; Urography; 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

Topics: Adolescent; Adult; Aged; Chronic Disease; Dietary Fats; Female; Folic Acid; Heart Failure; Humans; Malabsorption Syndromes; Male; Middle Aged; Vitamin B 12; Xylose

Topics: Anemia, Sideroblastic; Blood Transfusion; Bone Marrow; Diverticulum; Erythropoiesis; Female; Headache; Heart Failure; Humans; Intestinal Absorption; Intestinal Diseases; Middle Aged; Phenacetin; Prednisolone; Pyridoxal Phosphate; Pyridoxine; Vitamin B 12

Topics: Alkaline Phosphatase; Autopsy; Bone Marrow Cells; Chromosome Aberrations; Endocarditis; Eosinophilia; Eosinophils; Heart Failure; Humans; Karyotyping; Leukemia; Leukemia, Myeloid; Male; Microscopy, Electron; Middle Aged; Muramidase; Myocardium; Neutrophils; Sex Chromosomes; Vitamin B 12

Topics: Adenosine Triphosphate; Calcium; Cardiac Glycosides; Electrocardiography; Heart; Heart Failure; Humans; Orotic Acid; Pantothenic Acid; Potassium; Rheumatic Heart Disease; Vitamin B 12

Topics: Anemia, Aplastic; Bone Marrow; Bone Marrow Examination; Child; Chromium Isotopes; Deferoxamine; Folic Acid; Heart Failure; Hemosiderosis; Humans; Iron; Iron Chelating Agents; Liver; Male; Mononuclear Phagocyte System; Oxymetholone; Prednisone; Pyridoxine; Spleen; Splenectomy; Tissue Extracts; Transfusion Reaction; Vitamin B 12

Topics: Cholestasis; Heart Failure; Hepatitis; Humans; Jaundice; Liver Cirrhosis; Myocardial Infarction; Pulmonary Heart Disease; Vitamin B 12

During the active phase of viral hepatitis urinary folate loss was found to be 8.0 to 48.3 (mean 31.1) mug./day, compared with a normal urinary folate excretion of 0.1 to 18.0 (mean 9.5) mug./day. In cirrhosis and cardiac failure with congestive hepatomegaly the corresponding values were 25.8 to 55.0 (mean 35.7) mug./day and 2.5 to 61.6 (mean 26.9) mug./day, respectively. Urinary folate loss may be a significant factor in the aetiology of folate deficiency of chronic liver disease, particularly when dietary intake is poor.After prolonged dialysis in Visking casing urinary folate was almost totally dialysable, but an appreciable fraction of serum folate was not, even after 72 hours. The dialysable (free) folate fraction of serum and urine disappeared maximally during the first six hours' dialysis, and was virtually cleared after 24 hours' dialysis; clearance curves in normal individuals and in liver disease were comparable. The non-dialysable serum folate fraction was of similar magnitude in all subjects studied, in spite of marked variation in total folate, and probably represented protein-bound folate.

Topics: Adult; Biological Assay; Dialysis; Folic Acid; Folic Acid Deficiency; Heart Failure; Humans; Lactobacillus; Liver Diseases; Vitamin B 12

Topics: Adenosine Triphosphate; Blood Flow Velocity; Blood Pressure; Chelating Agents; Female; Folic Acid; Heart; Heart Failure; Heart Rate; Hemodynamics; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Muscle Contraction; Pyruvates; Respiration; Strophanthins; Sulfhydryl Compounds; Veins; Vitamin B 12

Topics: Adult; Aged; Female; Folic Acid; Heart Failure; Humans; Male; Middle Aged; Vitamin B 12

Topics: Adult; Aged; Female; Folic Acid; Heart Failure; Humans; Male; Middle Aged; Strophanthins; Vitamin B 12

Topics: Adrenal Cortex Hormones; Androgens; Blood Cell Count; Blood Transfusion; Deferoxamine; Electrocardiography; Folic Acid; Heart Failure; Humans; Iron; Liver Cirrhosis; Pathology; Physiology; Riboflavin; Surgical Procedures, Operative; Thalassemia; Thymectomy; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Clinical Laboratory Techniques; Geriatrics; Heart Failure; Humans; Vitamin B 12

Topics: Adenosine Triphosphate; Corrinoids; Heart Failure; Hematinics; Humans; Niacin; Niacinamide; Nicotinic Acids; Thiamine Pyrophosphate; Vitamin B 12

Topics: Heart Failure; Humans; Liver; Liver Diseases; Vitamin B 12; Vitamin B Complex

Topics: Corrinoids; Heart; Heart Failure; Humans; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Anemia; Anemia, Pernicious; Antacids; Anti-Bacterial Agents; Arthritis; Arthritis, Rheumatoid; Blood Pressure; Cortisone; Dibenzylchlorethamine; Dicumarol; Epilepsy; Ergot Alkaloids; Heart Failure; Heparin; Histamine Antagonists; Humans; Hyaluronoglucosaminidase; Hydantoins; Hypersensitivity; Hypertension; Hyperthyroidism; Imidazoles; Iodine; Iodine Isotopes; Kidney; Meperidine; Mephenesin; Methadone; Motion Sickness; Norepinephrine; Organomercury Compounds; Peptic Ulcer; Tetraethylammonium; Therapeutics; Thiouracil; Thrombosis; Veratrum; Vitamin B 12