vitamin-b-12 and Hematologic-Diseases

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.. Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.

Topics: Acute Kidney Injury; Hematologic Diseases; Humans; Liver Diseases; Neoplasms; Nutrition Disorders; Vitamin B 12

Hypercobalaminemia (high serum vitamin B12 levels) is a frequent and underestimated anomaly. Clinically, it can be paradoxically accompanied by signs of deficiency, reflecting a functional deficiency linked to qualitative abnormalities, which are related to defects in tissue uptake and action of vitamin B12. The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. These entities are essentially comprised of solid neoplasms, haematological malignancies and liver and kidney diseases. This review reflects the potential importance of the vitamin B12 assay as an early diagnostic marker of these diseases. A codified approach is needed to determine the potential indications of a search for high serum cobalamin and the practical clinical strategy to adopt upon discovery of elevated cobalamin levels. While low serum cobalamin levels do not necessarily imply deficiency, an abnormally high serum cobalamin level forms a warning sign requiring exclusion of a number of serious underlying pathologies. Functional cobalamin deficiency can thus occur at any serum level.

Topics: Biomarkers; Biomarkers, Tumor; Hematologic Diseases; Humans; Liver Diseases; Neoplasms; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Hypervitaminemia B12 or high serum level of cobalamin B12 is a frequent and clinical underestimated abnormality. Clinically, it can be sometimes paradoxically accompanied by signs of deficiency reflecting a functional deficit in relation to qualitative abnormalities related to defects in tissue uptake and action of vitamin B12. Etiological profile of hypervitaminemias B12 has mostly serious disease entities and for which early diagnosis is crucial to the plan rather than prognostic. These entities are represented mainly by solid malignancies, hematological malignancies and liver diseases. This reflects the potential significance that may have the dosage of vitamin B12 as an early marker of diagnosis of these diseases. Codified approach is needed to determine the potential indications of the search for a hypervitaminemia B12 and practice what to do to pass before the discovery of a high serum level of cobalamin.

Topics: Hematologic Diseases; Humans; Liver Diseases; Metabolic Diseases; Models, Biological; Neoplasms; Professional Practice; Prognosis; Up-Regulation; Vitamin B 12

Elevated levels of serum cobalamin may be a sign of a serious, even life-threatening, disease. Hematologic disorders like chronic myelogeneous leukemia, promyelocytic leukemia, polycythemia vera and also the hypereosinophilic syndrome can result in elevated levels of cobalamin. Not surprisingly, a rise of the cobalamin concentration in serum is one of the diagnostic criteria for the latter two diseases. The increase in circulating cobalamin levels is predominantly caused by enhanced production of haptocorrin. Several liver diseases like acute hepatitis, cirrhosis, hepatocellular carcinoma and metastatic liver disease can also be accompanied by an increase in circulating cobalamin. This phenomenon is predominantly caused by cobalamin release during hepatic cytolysis and/or decreased cobalamin clearance by the affected liver. Altogether it can be concluded that an observed elevation of cobalamin in blood merits the a full diagnostic work up to assess the presence of disease.

Topics: Animals; Biological Transport; Hematologic Diseases; Humans; Intestinal Absorption; Vitamin B 12

In response to research findings that 10% to 30% of people aged 51 years and older may have protein-bound vitamin B-12 malabsorption, the National Academy of Sciences' Institute of Medicine recommends that these people consume a majority of the new Recommended Dietary Allowance (RDA) of 2.4 micrograms/day in its synthetic form rather than in its food form. Protein-bound vitamin B-12 malabsorption in older adults has been attributed to reduced pepsin activity and gastric acid secretion, which interfere with cleavage of vitamin B-12 from dietary protein before absorption. Unlike patients with pernicious anemia, most people with protein-bound vitamin B-12 malabsorption produce intrinsic factor and have the ability to absorb synthetic vitamin B-12 normally. Early diagnosis is necessary to prevent the untoward effects of vitamin B-12 deficiency. A thorough assessment of vitamin B-12 status entails measurement of multiple biochemical assessment indexes, including serum vitamin B-12, methylmalonic acid, and homocysteine concentrations. Dietitians and other health care professionals should be aware of the prevalence of vitamin B-12 deficiency in older adults and be familiar with sources of synthetic vitamin B-12 to facilitate implementation of the new RDA.

Topics: Absorption; Age Factors; Aged; Dietary Proteins; Hematologic Diseases; Humans; Malabsorption Syndromes; Middle Aged; Nervous System Diseases; Nutrition Policy; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

At one time, the diagnosis of a deficiency of vitamin B12 or folate was considered to be relatively straightforward. As knowledge has accumulated, the limitations of such tests as serum vitamin level measurements and the Schilling test have become apparent. With the development of newer tests, atypical and subclinical deficiency states have been recognized. In this review, available tests used in the diagnosis of vitamin B12 and folate deficiency are discussed, and a rational approach to the diagnosis of these deficiency states is presented.

Topics: Antibodies; Clinical Laboratory Techniques; Clinical Trials as Topic; Decision Trees; Diagnosis, Differential; Erythrocytes; Folic Acid Deficiency; Hematologic Diseases; Homocysteine; Humans; Intrinsic Factor; Methylmalonic Acid; Nervous System Diseases; Parietal Cells, Gastric; Primary Health Care; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

In summary, we have shown that there is a high prevalence of Cbl deficiency in the elderly. This observation is based on an increase in the number of low and low normal serum Cbl levels, an increase in elevated serum total homocysteine levels that correct with Cbl therapy, and an increase in elevated serum methylmalonic acid levels that also correct with Cbl therapy. These observations may be of great clinical importance since Cbl deficiency may be a common and treatable cause of vascular disease.

Topics: Aged; Hematologic Diseases; Homocysteine; Humans; Mental Disorders; Methylmalonic Acid; Nervous System Diseases; Vascular Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Radioisotopes used in haematology may be divided into four groups: 1. those used for in vivo studies, involving the labelling of cells in the blood or bone marrow and the use of labelled plasma albumin; 2. investigations involving surface counting over organs such as the bone marrow, spleen, liver and heart; 3. in vitro use of radioisotopes in the haematology laboratory and 4. isotopes used as part of imaging procedures. The shorter the half life of the isotope, the more limited patient exposure to radioactivity will be, but the greater the problems of starting and completing the investigation before the isotope has decayed. Isotopes studies should not be carried out in children or pregnancy unless there are exceptional clinical indications.

Topics: Absorption; Blood Volume Determination; Hematologic Diseases; Humans; In Vitro Techniques; Iron; Plasma Volume; Radionuclide Imaging; Vitamin B 12

Topics: Blood Platelets; Bone Marrow; Erythrocyte Aging; Hematologic Diseases; Humans; Iron Radioisotopes; Isotope Labeling; Lymph Nodes; Radioimmunoassay; Radioisotopes; Radionuclide Imaging; Spleen; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Megaloblastic; Blood Platelets; Bone Marrow Cells; Bone Marrow Transplantation; Child; Factor VIII; Hematologic Diseases; Hematopoietic Stem Cells; Hemophilia A; Humans; Leukemia; Thalassemia; Vitamin B 12; von Willebrand Diseases

Topics: Aneuploidy; Basophils; Blood Platelets; Cell Transformation, Neoplastic; Child; Clinical Enzyme Tests; Cytogenetics; Eosinophilia; Fetal Hemoglobin; Fever; Hematologic Diseases; Humans; Leukemia, Myeloid; Leukocyte Count; Lymphatic Diseases; Muramidase; Primary Myelofibrosis; Prognosis; Skin Manifestations; Thrombocytosis; Vitamin B 12

Topics: Anemia, Pernicious; Blood Volume; Blood Volume Determination; Chromium Isotopes; Cobalt Isotopes; Erythrocyte Aging; Erythrocytes; Erythropoiesis; Hematologic Diseases; Humans; Intestinal Absorption; Iodine Radioisotopes; Iron; Iron Isotopes; Myeloproliferative Disorders; Phosphorus Isotopes; Radioisotopes; Radionuclide Imaging; Schilling Test; Serum Albumin, Radio-Iodinated; Surface Properties; Vitamin B 12

Topics: Blood Coagulation; Blood Group Antigens; Blood Platelets; Blood Transfusion; Bone Marrow Examination; Cell Survival; Complement System Proteins; Erythrocyte Aggregation; Erythrocytes; Erythropoiesis; Feces; Folic Acid; Hematologic Diseases; Hematopoietic System; Hemolysis; Humans; Intrinsic Factor; Iron; Isoantibodies; Kinetics; Leukocytes; Mononuclear Phagocyte System; Radioisotopes; Vitamin B 12

Topics: Amino Acids; Anemia, Pernicious; Cell Nucleus; Diet; DNA; Erythrocytes; Folic Acid; Folic Acid Deficiency; Glycine; Hematologic Diseases; Homocystine; Humans; Methionine; Polycythemia; Pyridoxine; Serine; Tetrahydrofolate Dehydrogenase; Thymine; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Aplastic; Anemia, Hemolytic; Anemia, Hemolytic, Congenital; Anemia, Hypochromic; Anemia, Pernicious; Anticoagulants; Chelating Agents; Erythroblastosis, Fetal; Exchange Transfusion, Whole Blood; Female; Fibrinolysis; Folic Acid Deficiency; Hematologic Diseases; Hemoglobinopathies; Hemophilia A; Hemophilia B; Humans; Infant, Newborn; Iron; Leukemia; Pregnancy; Splenectomy; Vitamin B 12; Vitamin B 12 Deficiency; Waldenstrom Macroglobulinemia

To assess the prevalence and determinants of haematinic deficiency (lack of B12 folate or iron) and macrocytosis in blood from a national population-based study of middle-aged and older adults.. A cross-sectional study involving 1,207 adults aged ≥45 years, recruited from a sub-study of the Irish National Survey of Lifestyle Attitudes and Nutrition (SLÁN 2007). Participants completed a health and lifestyle questionnaire and a standard food frequency questionnaire. Non-fasting blood samples were obtained for measurement of full blood count and expert morphological assessment, serum ferritin, soluble transferrin receptor assay (sTfR), B12, folate and coeliac antibodies. Blood samples were also assayed for thyroid function (T4, TSH), liver function, aminotransferase (AST) and gamma-glutamyl transferase (GGT).. The overall prevalence (95% C.I.) of anaemia (Hb <13.5 g/dl men and 11.3 g/dl women) was 4.6% (2.9%-6.4%) in men and 1.0% (0.2%-1.9%) in women. Iron deficiency (ferritin <17 ng/ml men and <11 ng/ml in women) was detected in 6.3% of participants (3.7% in males and 8.7% in females, p<0.001). Based on both low ferritin and raised sTfR (>21 nmol/ml) only 2.3% were iron-deficient. 3.0% and 2.7% were found to have low levels of serum folate (<2.3 ng/ml) and serum B12 (<120 ng/l) respectively. Clinically significant macrocytosis (MCV>99fl) was detected in 8.4% of subjects. Strong, significant and independent associations with macrocytosis were observed for lower social status, current smoking status, moderate to heavy alcohol intake, elevated GGT levels, deficiency of folate and vitamin B12, hypothyroidism and coeliac disease. The population attributable fraction (PAF) for macrocytosis associated with elevated GGT (25.0%) and smoking (24.6%) was higher than for excess alcohol intake (6.3%), folate deficiency (10.5%) or vitamin B12 (3.4%).. Haematinic deficiency and macrocytosis are common in middle-aged/older adults in Ireland. Macrocytosis is more likely to be attributable to an elevated GGT and smoking than vitamin B12 or folate deficiency.

Topics: Adult; Aged; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; gamma-Glutamyltransferase; Hematologic Diseases; Humans; Hypothyroidism; Ireland; Iron; Iron Deficiencies; Male; Middle Aged; Receptors, Transferrin; Smoking; Thyrotropin; Transaminases; Vitamin B 12; Vitamin B 12 Deficiency

Pemetrexed is a multitargeted folate pathway inhibitor with documented activity in non-small cell lung cancer (NSCLC). The presumed maximum tolerated dose is 500 mg/m2 every 3 weeks, but pemetrexed-related toxicity is ameliorated when folate and B12 supplementation is provided and therefore a higher dose intensity may be tolerated. The current exploratory study assessed the feasibility of administration of pemetrexed at a fixed dose of 1000 mg every 2 weeks in patients with relapsed or refractory NSCLC.. The first cohort of 12 patients received pemetrexed monotherapy. No dose-limiting grade 4 toxicity was noted after 4 cycles, so the subsequent cohort of 14 patients received additional anticancer agents (bevacizumab, erlotinib, carboplatin, docetaxel, vinorelbine) given along with dose-dense pemetrexed.. Toxicity overall was reversible and manageable. Among 19 patients who received pemetrexed either alone or with non-myelosuppressive targeted agents, there were only 2 instances of grade 4 neutropenia after prolonged treatment. Grade 3-4 hematologic toxicity was eventually noted in 11 of the 26 patients (42%; 95% confidence interval, 23% to 61%) after a median of 4 cycles (range, 2-14 cycles). There was no significant additional toxicity nor any treatment-related deaths.. Our preliminary observations indicate that dose-dense pemetrexed every 2 weeks is feasible and this regimen can be used as monotherapy. These data may serve as a scaffold for combination studies.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Non-Small-Cell Lung; Dose-Response Relationship, Drug; Drug Combinations; Feasibility Studies; Female; Folic Acid Antagonists; Glutamates; Guanine; Hematologic Diseases; Humans; Male; Neutropenia; Pemetrexed; Vitamin B 12

Gemcitabine (G) plus cisplatin (C) is standard care for metastatic transitional cell carcinoma (TCC) of the urothelium. Pemetrexed (P), alone or in combination with G, is active in metastatic TCC. However, the safety and efficacy of P combined with GC therapy is unknown. This phase I trial was designed to determine the maximum tolerated dose (MTD) of GC followed by P+G in patients with metastatic TCC.. Cohorts of 3 to 6 patients received escalating doses 28-day cycles (maximum 6 cycles): G 800-1,000 mg/m2 on days 1 and 15; P 400-500 mg/m2 on day 15; and C 50-70 mg/m2 on day 1. All patients received folic acid, vitamin B12, and full supportive care. The 3+3 standard phase I escalation rule was used to determine MTD.. Fifteen patients registered: 13/15 white males; median age 70 years (range, 53-82); 11/15 had KPS>or=90. At dose level 0, 2/4 patients experienced unrelated DLTs, and 1 patient was replaced (completed<1 cycle). Dose escalation proceeded to dose level 1. At level 1, 4/6 patients experienced DLTs; dosing decreased to level 0 and 4/5 patients experienced DLTs. The MTD was not determined. The 2 patients that completed 6 cycles both had partial responses. Grades 3-4 hematologic toxicities included neutropenia (60%), leukopenia (20%), and febrile neutropenia (13%).. Adding P to the standard GC regimen as first-line therapy for metastatic TCC produced no benefit. The MTD exceeded therapeutic gemcitabine and cisplatin doses for urothelial cancer and thus the study was aborted.

Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Transitional Cell; Cisplatin; Deoxycytidine; Dose-Response Relationship, Drug; Female; Folic Acid; Gemcitabine; Glutamates; Guanine; Hematologic Diseases; Humans; Male; Maximum Tolerated Dose; Middle Aged; Neoplasm Metastasis; Pemetrexed; Treatment Outcome; Urinary Bladder Neoplasms; Urothelium; Vitamin B 12; Vitamin B Complex

With the introduction of automated assays for measuring serum cobalamin levels over the last decades, the hematological manifestations related to cobalamin deficiency have been changed from the description reported in 'old' studies or textbooks. We studied the hematological manifestations or abnormalities in 201 patients (median age: 67 +/- 6 years) with well-documented cobalamin deficiency (mean serum vitamin B12 levels 125 +/- 47 pg/ml) extracted from an observational cohort study (1995-2003). Assessment included clinical features, blood count and morphological review. Hematological abnormalities were reported in at least two-third of the patients: anemia (37%), leukopenia (13.9%), thrombopenia (9.9%), macrocytosis (54%) and hypegmented neutrophils (32%). The mean hemoglobin level was 10.3 +/- 0.4 g/dl and the mean erythrocyte cell volume 98.9 +/- 25.6 fl. Approximately 10% of the patients have life-threatening hematological manifestations with documented symptomatic pancytopenia (5%), 'pseudo' thrombotic microangiopathy (Moschkowitz; 2.5%), severe anemia (defined as Hb levels <6 g/dl; 2.5%) and hemolytic anemia (1.5%). Correction of the hematological abnormalities was achieved in at least two-thirds of the patients, equally well in patients treated with either intramuscular or oral crystalline cyanocobalamin. This study, based on real data from a single institution with a large number of consecutive patients with well-documented cobalamin deficiency, confirms several 'older' findings that were previously reported before the 1990s in several studies and in textbooks.

Topics: Aged; Aged, 80 and over; Cell Size; Female; Follow-Up Studies; Hematologic Diseases; History, 20th Century; Humans; Male; Middle Aged; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

A prospective, randomized study was conducted to evaluate the role of vitamin B12 and folinic acid supplementation in preventing zidovudine (ZDV)-induced bone marrow suppression. Seventy-five human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts < 500/mm3 were randomized to receive either ZDV (500 mg daily) alone (group I, n = 38) or in combination with folinic acid (15 mg daily) and intramascular vitamin B12 (1000 micrograms monthly) (group II, n = 37). Finally, 15 patients were excluded from the study (noncompliance 14, death 1); thus, 60 patients (31 in group I and 29 in group II) were eligible for analysis. No significant differences between groups were found at enrollment. During the study, vitamin B12 and folate levels were significantly higher in group II patients; however, no differences in hemoglobin, hematocrit, mean corpuscular volume, and white-cell, neutrophil and platelet counts were observed between groups at 3, 6, 9 and 12 months. Severe hematologic toxicity (neutrophil count < 1000/mm3 and/or hemoglobin < 8 g/dl) occurred in 4 patients assigned to group I and 7 assigned to group II. There was no correlation between vitamin B12 or folate levels and development of myelosuppression. Vitamin B12 and folinic acid supplementation of ZDV therapy does not seem useful in preventing or reducing ZDV-induced myelotoxicity in the overall treated population, although a beneficial effect in certain subgroups of patients cannot be excluded.

Topics: Adult; Anemia; Bone Marrow Diseases; CD4 Lymphocyte Count; Female; Folic Acid; Hematologic Diseases; HIV Infections; Humans; Leucovorin; Male; Neutropenia; Prospective Studies; Vitamin B 12; Zidovudine

Topics: Blood Volume Determination; Chromium Isotopes; Clinical Trials as Topic; Cobalt Isotopes; Erythrocyte Aging; Hematologic Diseases; Humans; Iron Isotopes; Leukemia, Lymphoid; Phosphorus Isotopes; Radioisotopes; Thrombocytopenia; Vitamin B 12

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

Topics: Acute Disease; Aged; Aged, 80 and over; Comorbidity; Cross-Sectional Studies; Female; France; Health Services for the Aged; Hematologic Diseases; Humans; Male; Middle Aged; Neoplasms; Vitamin B 12

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

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

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

Topics: Aged; Autoimmune Diseases; Female; France; Hematologic Diseases; Humans; Liver Diseases; Male; Metabolic Diseases; Neoplasms; Prevalence; Prognosis; Renal Insufficiency; Statistics as Topic; Vitamin B 12

The objective of this study was to investigate the propensity of potassium bromate (KBrO3) to induce oxidative stress in blood and bone of adult mice and its possible attenuation by vanillin. Our results demonstrated, after KBrO3 treatment, a decrease of red blood cells and hemoglobin and a significant increase of white blood cell. A decrease in plasma levels of folic acid, vitamin B12 and iron was also noted. Interestingly, an increase of lipid peroxidation, hydroperoxides, hydrogen peroxide, advanced oxidation protein products and protein carbonyl levels in erythrocytes and bone was observed, while superoxide dismutase, catalase and glutathione peroxidase activities and glutathione, non-protein thiol and vitamin C levels were decreased. KBrO3 treatment resulted in blood and bone DNA fragmentation, a hallmark of genotoxicity-KBrO3-induced, with reduction of DNA levels. Calcium and phosphorus levels showed a decrease in the bone and an increase in the plasma after KBrO3 treatment. These biochemical alterations were accompanied by histological changes in the blood smear and bone tissue. Treatment with vanillin improved the histopathological, hematotoxic and genotoxic effects induced by KBrO3. The results showed, for the first time, that the vanillin possesses a potent protective effect against the oxidative stress and genotoxicity in bone and blood of KBrO3-treated mice.

Topics: Animals; Antioxidants; Benzaldehydes; Bone Diseases; Bromates; Calcium; DNA Fragmentation; Enzymes; Erythrocytes; Femur; Folic Acid; Hematologic Diseases; Lipid Peroxidation; Mice; Oxidative Stress; Phosphorus; Platelet Count; Protective Agents; Vitamin B 12

In general practice, vitamin B12 levels are measured when searching an origin for an anemic status (usually megaloblastic anemia), for various neurological disorders (usually polyneuropathy) or for neurocognitive disorders. Although the pathologies associated with vitamin B12 deficiency are well known, hypervitaminemic B12 status is often fortuitous and frequent finding. The aim of this article is to present the disease entities associated with hypervitaminemia B12, the clinical implications of this dysvitaminosis and a practical approach when this laboratory abnormality is found.

Topics: Algorithms; Autoimmune Diseases; Female; Hematologic Diseases; Humans; Liver Diseases; Neoplasms; Pregnancy; Premature Birth; Renal Insufficiency; Vitamin B 12

The high incidence of cobalamin (vitamin B12) deficiency results in frequent dosages of this vitamin in a department of internal medicine may reveal paradoxically high blood levels of cobalamin. The objective of the study was to estimate underlying diseases and potential diagnostic relevance of high cobalamin blood levels in internal medicine.. A retrospective study was conducted, including in-patients from December 2005 to July 2006 presenting high cobalamin blood levels, as determined with our laboratory normal values (200-950 pg/mL).. High cobalamin blood level is not unusual (18.5% of all dosages) and, most of time, it is associated with one or several diseases, among which acute and chronic liver diseases (often of alcoholic origin), various neoplasias, malignant hemopathies (myelodysplasia, myeloproliferative diseases, multiple myeloma), renal insufficiency and transient hematologic abnormalities (neutrophilic hyperleucocytosis, hypereosinophilia). Vitamin B12 supplementation and chronic myeloid leukemia represent less than 5% of all hypervitaminemia. There is no correlation between the level of cobalamin blood level and the number of underlying diseases for each patients. However, very high cobalamin blood levels (>1275 pg/mL) are significantly associated to malignant hemopathies (p<0.05). It is noteworthy that most of diagnosed neoplasia were unknown and at a non-metastatic stage.. Very high cobalamin blood levels are significantly associated to malignant hemopathies among the population of a department of internal medicine. Referent laboratory should actively advertise the numerous diseases involved with high cobalamin blood levels.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Female; Hematologic Diseases; Hematologic Neoplasms; Humans; Inpatients; Internal Medicine; Male; Middle Aged; Retrospective Studies; Vitamin B 12

Approximately 15% of people aged more than 60 years old have a cobalamin (vitamin B12) deficiency, mainly in relation with food-cobalamin malabsorption (FCM). To date, no study has documented this disorder in the elderly. There is also little information on clinical consequences.. We studied 92 elderly patients with well-established FCM who were extracted from an observational cohort study (1995-2004) of 172 consecutive elderly patients with documented cobalamin deficiency.. The median patient age was 76 +/- 8 years; 60 patients were women. The most common clinical manifestations were neurologic or psychologic: mild sensory polyneuropathy (44.6%), confusion or impaired mental functioning (22.8%), and physical asthenia (20.7%). Hematologic abnormalities were reported in at least one third of the patients: anemia (21%), leukopenia (10.9%), thrombopenia (8.7%), and pancytopenia (6.5%). All patients had low serum vitamin B12 levels (<200 pg/mL), with a mean value (+/- standard deviation) of 131 +/- 38 pg/mL and total serum homocysteine level of 22.1 +/- 9.3 micromol/L. The mean hemoglobin level was 10.9 +/- 2.5 g/dL and the mean erythrocyte cell volume 95.7 +/- 12.7 fL. Correction of the serum vitamin B12 levels and hematologic abnormalities was achieved equally well in patients treated with either intramuscular or oral crystalline cyanocobalamin.. This study suggests that in elderly patients, FCM may be associated with significant neurologic, psychologic, and hematologic abnormalities, which seem to respond equally well to either oral or parenteral vitamin B12 therapy.

Topics: Aged; Aged, 80 and over; Asthenia; Cognition Disorders; Cohort Studies; Confusion; Edema; Erythrocyte Indices; Female; Follow-Up Studies; Gastritis, Atrophic; Hematologic Diseases; Hemoglobins; Homocysteine; Humans; Jaundice; Malabsorption Syndromes; Male; Paresthesia; Polyneuropathies; Reflex, Abnormal; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Ceruloplasmin; Copper; Female; Follow-Up Studies; Hematologic Diseases; Humans; Magnetic Resonance Imaging; Metabolic Diseases; Middle Aged; Nervous System Diseases; Neural Conduction; Neutropenia; Peripheral Nerves; Spinal Cord; Vitamin B 12; Zinc

Topics: Administration, Oral; Aged; Aged, 80 and over; Female; Hematologic Diseases; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Elevated levels of serum cobalamin may be a sign of a serious, even life-threatening, disease. Diseases such as chronic myeloid leukaemia, promyelocytic leukaemia, polycythaemia vera and hypereosinophilic syndrome are often accompanied by markedly elevated levels of cobalamin in the blood. A rise in the serum cobalamin concentration is one of the diagnostic criteria for polycythaemia vera and hypereosinophilic syndrome. In haematological disorders, the increase in circulating cobalamin levels is predominantly caused by enhanced production of haptocorrin. Several liver diseases such as acute hepatitis, cirrhosis of the liver, hepatocellular carcinoma and metastatic liver disease can also be accompanied by an increase in circulating cobalamin. In liver diseases, the increase in cobalamin is predominantly caused by cobalamin release during hepatic cytolysis and/or through decreased clearance of circulating cobalamin by the affected liver. Liver disorders are not an indication for determining the serum cobalamin concentration. However, a coincidentally observed elevated serum cobalamin concentration is reason for further investigation.

Topics: Hematologic Diseases; Humans; Leukemia; Liver Diseases; Transcobalamins; Vitamin B 12

Four patients with congenital dyserythropoiesis characterized by marked macrocytosis, little or no anaemia, and vitamin B12- and folate-independent megaloblastic erythropoiesis are reported. Their erythroblasts also showed various dysplastic changes but not those diagnostic for congenital dyserythropoietic anaemia (CDA) types I or III. The haematological features of the four patients, who included two siblings, resemble those of a previously reported patient and together these patients form a recognizable subgroup within those cases of CDA not belonging to CDA types I-III. In two of the cases studied, and possibly a third, the inheritance was as an autosomal recessive character.

Topics: Adult; Anemia, Dyserythropoietic, Congenital; Child; Erythropoiesis; Female; Folic Acid; Hematologic Diseases; Humans; Male; Megaloblasts; Vitamin B 12

With the enormous range of laboratory investigations available from a modern haematology laboratory it is not surprising that a clinician may at times feel 'at sea' when finding a way through the diagnostic process. It is hoped that this 'haematological map' will help the busy clinician.

Topics: Algorithms; Blood Sedimentation; Erythrocyte Count; Erythrocyte Indices; Ferritins; Hematologic Diseases; Hemolysis; Hemostasis; Humans; Leukocyte Count; Predictive Value of Tests; Sensitivity and Specificity; Transferrin; Vitamin B 12

On purpose to study the radioassay of serum vitamin B12 and folic acid using non boil methods in with these two vitamins were released from their endogenous binding proteins with alkaline denaturation and separated the bound vitamins from the free ones with the magnetic iron particles coated these vitamin binders (purified hog intrinsic factor and beta-lactoglobulin from cow milk) were evaluated on precision and accuracy, compared with boil radioassay. 1. The reproducibilities of non boil method were 4.5 +/- 2.5% on vit. B12 and 3.5 +/- 0.2% on folate (n = 10), respectively. 2. The recovery test of the two serum vitamins with the use of cyanocobalamin and pteroylglutamic acid (J.P.) were finely showed the rations of 95.2-99.0% for vit. B12 and 101.0-108.0% for folic acid. And that of folic acid use of 5-methyl-tetrahydro-pteroylglutamic acid was showed the ratios of 101.0-104.0%. The values of folic acid measured by this method were found slightly higher than non boil method using conventional standard. 3. The correlation coefficient between non boil method and boil method were 0.987 and regression equation was showed y = 0.97x + 73.59 for vit. B12 (n = 75) and r = 0.932, y = 1.02x-0.08 (n = 78) for folic acid. 4. Normal range of serum total vit. B12 concentration was 210-920 (484 +/- 160 pg/ml, n = 259) and that of folic acid was 2.5-9.2 (5.2 +/- 1.4 ng/ml, n = 257), as well as boil method. 5. Accordingly it was considered that non boil (new standard) method was excellent for estimation of vitamin B12 and folic acid clinical status.

Topics: Female; Folic Acid; Hematologic Diseases; Humans; Liver Diseases; Male; Radioligand Assay; Reference Values; Vitamin B 12

Twenty-seven patients with multiple sclerosis had mild but significant macrocytosis when compared with an individually matched neurological control group and the normal laboratory reference range. The cause of the macrocytosis is unknown, but our recent clinical observations implicate a possible disturbance in vitamin B12 metabolism, binding or transport.

Topics: Adolescent; Adult; Female; Hematologic Diseases; Humans; Male; Middle Aged; Multiple Sclerosis; Retrospective Studies; Vitamin B 12

A poodle-type dog with bone marrow dyscrasia and macrocytosis was investigated by clinicopathological, cytological and ultrastructural means. Peripheral blood analysis revealed macrocytosis and the presence of nucleated erythroid cells, some with nuclear/cytoplasmic asynchrony. Tendencies towards neutropenia and granulocytic hypersegmentation were observed. Bone marrow examination revealed low normal myeloid to erythroid ratio, the presence of megaloblasts and some giant metamyelocytes. In addition, there were abnormal mitoses, binuclearity and multinuclearity, incomplete nuclear membranes and nuclear clefts, intracytoplasmic parallel-sided membranes and apparent degenerate erythroid cells. Blood biochemical tests indicated normal to high concentrations of serum vitamin B12, serum folate and red cell folate. Transcobalamin I/IIIB12-binding capacity was similar to values for normal dogs, but transcobalamin II-binding capacity appeared high. It was concluded that the condition had similarities to both congenital dyserythropoietic disorders and true megaloblastic conditions, but until further investigations are reported it might be wise to refer to it as "bone marrow dyscrasia" in poodles.

Topics: Animals; Bone Marrow Diseases; Dog Diseases; Dogs; Erythrocytes, Abnormal; Folic Acid; Hematologic Diseases; Male; Microscopy, Electron; Transcobalamins; Vitamin B 12

Topics: Binding, Competitive; Erythrocytes; Evaluation Studies as Topic; Folic Acid; Hematologic Diseases; Humans; Radioimmunoassay; Radioligand Assay; Reagent Kits, Diagnostic; Vitamin B 12

Serum cobalamin "analogue" levels were estimated by the discrepancy in cobalamin results with radioassays done with pure intrinsic factor and R binder in 364 patients with low cobalamin levels. No differences were found among the various causes of low cobalamin levels, except for the lower "analogue" levels among pregnant women. However, 76 patients with low cobalamin levels and primarily neurologic (spinal cord, neuropathic, cerebral, or a combination of these) symptoms had significantly higher "analogue" levels than 19 patients with primarily hematologic abnormalities. Moreover, the "analogue" levels correlated with hemoglobin values and were significantly higher in patients without megaloblastic changes in their bone marrow than in patients with megaloblastosis. An analysis limited to 47 patients with pernicious anemia yielded similar findings. The seven patients with only neurologic abnormalities had higher "analogue" levels than did the nine patients with only hematologic abnormalities. Because of the higher "analogue" levels, the assay done with R binder failed to register low cobalamin levels in 33 of 76 patients with low cobalamin levels and primarily neurologic abnormality (compared with only two of 19 with hematologic abnormality) and in 10 of 20 patients with pernicious anemia who had neurologic abnormalities (compared with only two of 12 without such abnormalities). These differences between patients with hematologic disturbances and patients with neurologic disturbances, and the inverse relationship of "analogue" level with severity of anemia, suggest that the disproportionate accumulation of analogues may explain why some patients with cobalamin deficiency display neurologic abnormalities while others do not.

Topics: Adult; Aged; Anemia, Pernicious; Female; Hematologic Diseases; Humans; Middle Aged; Nervous System Diseases; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

A representative sample (n = 486) of a 75-year-old population was studied, and probands with defined laboratory aberrations were re-investigated. Anaemia was present in 6% of the men and 3% of the women; in 17/22 anaemic subjects a cause was found. The prevalence of plasma cobalamin concentrations less than 130 pmol/l was 6%, of iron deficiency approximately 6%. Divergences in white blood cell and platelet counts were rare. The observed haematological aberrations were almost always caused by disease. Reference intervals for haematological components were calculated in the total study group and two reference sample groups after exclusions based on anamnestic and/or laboratory screening criteria or anamnestic criteria and/or verified disease. The lower reference limits for B-Hb and P-B12 in a group obtained after exclusions based on anamnestic and screening data were considered to be minimum values for healthy subjects. The WHO criteria for anaemia were applicable.

Topics: Aged; Aging; Anemia; Anemia, Hypochromic; Female; Hematologic Diseases; Hemoglobins; Humans; Longitudinal Studies; Male; Sweden; Vitamin B 12

Our information about cobalamin transport in the blood is largely based on studies of unsaturated cobalamin-binding proteins. Therefore, the distribution of endogenous cobalamin among these proteins was examined. Normally, R binder (transcobalamin I) carries most of the cobalamin circulating at any given moment, but the proportion varies greatly. Transcobalamin II carries a larger fraction of the cobalamin present in portal vein blood than in hepatic and axillary vein blood. In disease, transcobalamin II occasionally holds the bulk of the vitamin present in peripheral blood. Such was observed in three patients showing quantitative changes of unsaturated binder (either diminished R binder or increased transcobalamin II), but in two cases of chronic liver disease this was independent of unsaturated transcobalamin levels. Four patients with low serum cobalamin levels maintained normal distribution, indicating proportional cobalamin depletion from both binder pools. Small amounts of vitamin were attached in many sera to minor binders, and occasionally seemed to circulate free. These results demonstrate that assumptions that cobalamin is always attached largely to transcobalamin I are not warranted. Cobalamin distribution appears to be governed by many factors, of which the amounts of the binding proteins is only one.

Topics: Axillary Vein; Health Status; Hematologic Diseases; Hepatic Veins; Humans; Liver Diseases; Multiple Myeloma; Myeloproliferative Disorders; Portal Vein; Transcobalamins; Vitamin B 12

Topics: Binding, Competitive; Cobalt Radioisotopes; Erythrocytes; Evaluation Studies as Topic; Folic Acid; Hematologic Diseases; Humans; Iodine Radioisotopes; Liver Diseases; Radioligand Assay; Reagent Kits, Diagnostic; Vitamin B 12

Topics: Female; Folic Acid; Hematologic Diseases; Humans; Male; Radioimmunoassay; Reagent Kits, Diagnostic; 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

By means of a test set of the Isocommerz (GDR) determinations of vitamin B12 in the serum were carried out according to the principle of the competitive protein binding. The normal values lie between 200 and 1,000 pg/ml serum. Clearly decreased levels of vitamin B12 are found in the pernicious anaemia, in other megaloblastic anaemias and in disturbances of the resorption after resection of the stomach. Increased values can be stated in the untreated chronic myelosis and in the blast episode. Under Busulphan-therapy a significant decrease of the values of vitamin B12 develops. The method seems to be practically important for the well-timed recognition of deficiency conditions of vitamin B12 in beginning pernicious anaemia, in disturbances of intestinal resorption after resection of the stomach and for the observation of the course of the chronic myelosis.

Topics: Acute Disease; Anemia, Pernicious; Busulfan; Hematologic Diseases; Humans; Leukemia; Leukemia, Myeloid; Polycythemia; Postgastrectomy Syndromes; Vitamin B 12

Alcohol causes different hematologic alterations on each of the three bone marrow cellular series. Its effect on the red series leads to the appearance of megaloblastic disturbances, erythroblastic vacuolization, iron metabolism abnormalities, and hemolytic syndromes. Megaloblastic disturbances may arise as a consequence of folic acid or vitamin B12 deficiency or of a direct toxic effect of ethanol on the erythroblasts. Iron metabolism alterations include reversible sideroblastic anemia, and hemosiderosis. The three hemolytic syndromes related to the consumption of ethanol are: acanthocytosis, stomatocytosis, and Zieve's syndrome. Alcohol induces leukopenia and functional deffects of the leukocytes; these facts explain the frequent susceptibility of chronic alcoholics to infection. Ethanol may act upon the megakaryocytic series to produce reversible thrombopenia and various alterations in platelet function. Thus alcohol exerts toxic effects on bone marrow, which interfere with the proliferation, maturation, release and survival of the three cellular series, either directly or by means of complex mechanisms related to the metabolism of folic acid, vitamin B12, pyridoxine, or iron. Alcoholism should therefore be considered as a possible cause whenever an obscure hematological condition comes under scrutiny.

Topics: Alcoholism; Bone Marrow Diseases; Erythrocytes; Ethanol; Folic Acid; Hematologic Diseases; Humans; Intestinal Absorption; Iron; Leukocytes; Megakaryocytes; Pyridoxine; Vitamin B 12

Topics: Blood Donors; Female; Hematologic Diseases; Hepatitis; Humans; Pregnancy; Vitamin B 12

Hematological and histological studies of the rabbit brachydactyly mutant were made to clarify the question of the blood abnormality that had previously been implicated in the teratogenic process leading to congenital amputation. The hemoglobin of fetal and adult br/br rabbits, studied by electrophoresis and cyanmethemoglobin assay, exhibited no differences from that of controls. The br/br fetuses were polycythemic and severely macrocytic. Fetal limb vessels showed thrombosis leading to hemorrhages in the extremities. The hepatic tissue was abnormal, being particularly poor in hematopoietic cells; blood cell macrocytosis was attributed to impaired erthropoiesis. Treatment of pregnant rabbits with folic acid plus vitamin B12 or with folinic acid was able simultaneously to prevent the fetal blood cell macrocytosis and the congenital abnormalities.

Topics: Abnormalities, Multiple; Animals; Blood Cell Count; Drug Therapy, Combination; Electrophoresis, Cellulose Acetate; Erythrocytes, Abnormal; Erythropoiesis; Extremities; Female; Folic Acid; Hematologic Diseases; Hemoglobinometry; Homozygote; Inbreeding; Leucovorin; Limb Deformities, Congenital; Liver; Maternal-Fetal Exchange; Pregnancy; Rabbits; Vitamin B 12

Topics: Adult; Aged; Biological Assay; Blood Preservation; Evaluation Studies as Topic; Female; Hematologic Diseases; Humans; Lactobacillus; Male; Methods; Middle Aged; Radioisotopes; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Androgens; Child; Folic Acid; Glucocorticoids; Hematologic Diseases; Humans; Iron; Transfusion Reaction; Vitamin B 12; Vitamin E

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cobalt Radioisotopes; Female; Hematologic Diseases; Humans; Male; Methods; Middle Aged; Vitamin B 12

Since trimethoprim-sulfamethoxazole (TMP-SMX) was first marked occasional reviews have surveyed the pattern of adverse reactions. Skin rashes characteristic of sulfonamide sensitivity have predominated, with relatively few of a serious exfoliative nature. Hematologic adverse reactions recorded follow the pattern known to occur with sulfonamides, with a few cases related to the action of trimethoprim on human folate metabolism. Such an effect is more likely to occur when the patient's folate status is already jeopardized; it is rare in relation to the widespread use of the drug combination. Long-term administration does not per se seem to represent an additional hazard provided the dose is the correct one and the hematologic monitoring of the patient is performed regularly. The suggestion that TMP-SMX has a toxic effect on the kidney has not been substantiated. An estimated 250 million "standard treatment courses" have been given in the first 6 years of marketing and, overall, the picture of adverse reactions corresponds with that expected from a sulfonamide of relatively low toxicity.

Topics: Adult; Aged; Bacterial Infections; Blood Cell Count; Blood Cells; Blood Platelets; Child; Drug Combinations; Drug Eruptions; Drug Evaluation; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Gastrointestinal Diseases; Hematologic Diseases; Hemoglobins; Humans; Long-Term Care; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Vitamin B 12

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

Topics: Hematologic Diseases; Humans; Radioisotope Dilution Technique; Vitamin B 12

Topics: Agranulocytosis; Ammonium Sulfate; Blood Proteins; Chemical Precipitation; Chromatography, DEAE-Cellulose; Chromatography, Gel; Cobalt Radioisotopes; Hematologic Diseases; Humans; Leukemia, Myeloid; Leukocytosis; Methods; Neutrophils; Polycythemia Vera; Protein Binding; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia; Deficiency Diseases; Erythrocytes; Folic Acid; Gastrectomy; Hematologic Diseases; Humans; Iron; Male; Middle Aged; Neutrophils; Transferrin; Vitamin B 12

Topics: Anemia, Hemolytic, Congenital; Anemia, Pernicious; Chromium Isotopes; Erythrocyte Aging; Hematologic Diseases; Humans; Iron; Iron Isotopes; Radioisotopes; Thalassemia; Vitamin B 12; Vitamin B 12 Deficiency

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: Adolescent; Adult; Aged; Anemia; Anemia, Hypochromic; Biliary Tract Diseases; Biometry; Cardiovascular Diseases; Erythrocyte Count; Erythrocytes; Erythrocytes, Abnormal; Female; Gastrointestinal Diseases; Hematologic Diseases; Hemophilia A; Humans; Leukemia; Liver Diseases; Lung Diseases; Male; Middle Aged; Neoplasms; Pancreatic Diseases; Splenectomy; Thalassemia; Thyroid Diseases; Urologic Diseases; Vitamin B 12

Topics: Adolescent; Adult; Age Factors; Aged; Anemia; Antineoplastic Agents; Child; Child, Preschool; Diagnosis, Differential; Hematologic Diseases; Humans; Leukemia; Lymphadenitis; Middle Aged; Plasmacytoma; Prognosis; Vitamin B 12

Topics: Adolescent; Adult; Cobalt Isotopes; Female; Hematologic Diseases; Humans; Intrinsic Factor; Leukemia; Male; Middle Aged; Radioisotope Dilution 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: Age Factors; Aged; Anemia; Anemia, Hypochromic; Arthritis, Rheumatoid; Blood Chemical Analysis; Blood Proteins; Blood Sedimentation; Bronchitis; England; Feces; Female; Folic Acid; Folic Acid Deficiency; Health Surveys; Hematologic Diseases; Hemoglobins; Hospitalization; Humans; Iron; Middle Aged; Neoplasms; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Antidepressive Agents; Barbiturates; Chronic Disease; Epilepsy; Female; Folic Acid; Folic Acid Deficiency; Hematologic Diseases; Humans; Male; Middle Aged; Neurocognitive Disorders; Phenothiazines; Schizophrenia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Hematologic Diseases; Humans; Iron; Liver Diseases; Vitamin B 12

Topics: Age Factors; Arthritis, Rheumatoid; Chronic Disease; Erythrocyte Aging; Hematologic Diseases; Humans; Reticulocytes; Sex Factors; Vitamin B 12

Topics: Adult; FIGLU Test; Folic Acid; Hematologic Diseases; Histidine; Humans; Liver; Male; Middle Aged; Spectrophotometry; Vitamin B 12

Topics: Adult; Aged; Barbiturates; Chronic Disease; Female; Folic Acid; Hematologic Diseases; Humans; Male; Mental Disorders; Middle Aged; Nutritional Physiological Phenomena; Phenothiazines; Pregnancy; Vitamin B 12

Topics: Adolescent; Adult; Aged; Agranulocytosis; Anemia; Bone Marrow; Bone Marrow Cells; Cell Division; Cell Nucleus; Diploidy; DNA; Erythrocytes; Erythropoiesis; Female; Hematologic Diseases; Hemorrhage; Humans; Male; Middle Aged; Photometry; Polycythemia; Reticulocytes; Time Factors; Vitamin B 12

Topics: Adjustment Disorders; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Asthenia; Biliary Tract Diseases; Female; Gastrointestinal Diseases; Hematologic Diseases; Humans; Hypotension; Leukemia; Lung Diseases; Male; Middle Aged; Porphyrins; Pyridoxine; Urologic Diseases; Vitamin B 12

Topics: Alpha-Globulins; Beta-Globulins; Bone Marrow Diseases; Diagnosis, Differential; Female; Hematologic Diseases; Humans; Leukemia, Myeloid; Polycythemia Vera; Pregnancy; Pregnancy Complications, Hematologic; Primary Myelofibrosis; Prognosis; Protein Binding; Uremia; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Chromatography; Cobalt Isotopes; Feces; Folic Acid; Gastrointestinal Diseases; Hematologic Diseases; Humans; Intestinal Diseases; Leukemia; Myelitis; Radiometry; Stomach Diseases; Tritium; Vitamin B 12

Topics: Cobalt Isotopes; Hematologic Diseases; Humans; Methods; Vitamin B 12

Topics: Blood Platelets; Blood Transfusion; Hematologic Diseases; Hemorrhage; Humans; Iatrogenic Disease; Leukemia; Lymphoma; Thalassemia; Vitamin B 12

Topics: Chromium Isotopes; Cobalt Isotopes; Hematologic Diseases; Humans; Kidney Diseases; Vitamin B 12

Topics: Adolescent; Animals; Child; Child, Preschool; Female; Hematologic Diseases; Humans; Infant; Infections; Kidney Diseases; Lactobacillus; Liver Diseases; Male; Rats; Rheumatic Fever; Vitamin B 12

Topics: Chromatography, Thin Layer; Hematologic Diseases; Humans; Malonates; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Hematologic Diseases; Humans; Iron; Radiometry; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Biological Transport; Blood; Cobalt Isotopes; Feces; Gastrointestinal Absorption; Hematologic Diseases; Humans; Intestinal Absorption; Iron; Metabolism; Radiometry; Urine; Vitamin B 12

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

Topics: Adolescent; Alkalies; Anemia; Anemia, Hypochromic; Anemia, Pernicious; Blood Chemical Analysis; Erythrocytes; Gastrectomy; Geriatrics; Hematologic Diseases; Humans; Lactobacillus; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Polycythemia Vera; Vitamin B 12; Vitamins

Topics: Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Pernicious; Blood Coagulation; Blood Proteins; Chloramphenicol; Epidemiology; Epoetin Alfa; Erythropoietin; Haptoglobins; Hematologic Diseases; Hematology; Hemochromatosis; Humans; Iron-Dextran Complex; Leukemia; Polycythemia; Thromboplastin; 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, Pernicious; Autoantibodies; Hematologic Diseases; Humans; Intrinsic Factor; Pathology; Stomach; Thyroid Gland; Thyroiditis; Thyroiditis, Autoimmune; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Pernicious; Biological Assay; Blood Chemical Analysis; Chromatography; Erythrocytes; Folic Acid; Folic Acid Deficiency; Hematologic Diseases; Humans; Lactobacillus; Metabolism; Methotrexate; Vitamin B 12

Topics: Chromium Isotopes; Cobalt Isotopes; Corrinoids; Diagnosis; Hematologic Diseases; Hematology; Humans; Iron; Iron Isotopes; Metabolism; Radiometry; Vitamin B 12

Topics: Adolescent; Adrenocorticotropic Hormone; Anti-Bacterial Agents; Antibiotics, Antitubercular; Benzene; Blood Transfusion; Cortisone; Folic Acid; Hematologic Diseases; Hematology; Iron; Occupational Diseases; Toxicology; Vitamin B 12; Vitamin K

Topics: Adrenocorticotropic Hormone; Anemia; Anemia, Myelophthisic; Anti-Bacterial Agents; Ascorbic Acid; Benzene; Biopsy; Blood Transfusion; Cortisone; Female; Hematologic Diseases; Hematology; Leukemia; Liver Extracts; Mortality; Occupational Diseases; Pathology; Poisoning; Prednisolone; Prednisone; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Tetracycline; Toxicology; Vasopressins; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Corrinoids; Hematinics; Hematologic Diseases; Humans; Vitamin B 12

Topics: Anemia; Anemia, Hemolytic; Corrinoids; Hematinics; Hematologic Diseases; Liver Extracts; Vitamin B 12

Topics: Cobalt; Cobalt Radioisotopes; Gastroenterology; Hematologic Diseases; Humans; Neurology; Radioactivity; Vitamin B 12

Topics: Corrinoids; Heart Diseases; Hematinics; Hematologic Diseases; Humans; Neoplasms; Vitamin B 12

Topics: Bone Marrow; Bone Marrow Diseases; Hematologic Diseases; Hodgkin Disease; Humans; Leukemia; Myeloproliferative Disorders; Polycythemia Vera; Vitamin B 12

Topics: Hematinics; Hematologic Diseases; Humans; Vitamin B 12

Topics: Erythroblastosis, Fetal; Fetus; Hematologic Diseases; Vitamin B 12

Topics: Hematologic Diseases; Humans; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Corrinoids; Hematologic Diseases; Humans; Polycythemia Vera; Vitamin B 12

Topics: Body Fluids; Hematologic Diseases; Humans; Liver Diseases; Vitamin B 12

Topics: Biological Assay; Corrinoids; Hematinics; Hematologic Diseases; Humans; Lactobacillus; Neoplasms; Vitamin B 12

Topics: Achlorhydria; Aged; Anemia; Ascorbic Acid; Hematologic Diseases; Humans; Iron; Polycythemia Vera; Vitamin B 12

Topics: Anemia; Endocrine System Diseases; Eukaryota; Hematologic Diseases; Humans; Leukemia; Liver Diseases; Vitamin B 12

Topics: Corrinoids; Hematinics; Hematologic Diseases; Humans; Vascular Diseases; Vitamin B 12

Topics: Hematinics; Hematologic Diseases; Humans; Leukemia; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Folic Acid; Hematinics; Hematologic Diseases; Humans; Vitamin B 12

Topics: Corrinoids; Erythrocytes; Hematologic Diseases; Hematologic Tests; Humans; Vitamin B 12

Topics: Anemia; Corrinoids; Hematinics; Hematologic Diseases; Humans; Prognosis; Vitamin B 12