B12 deficiency with neurological manifestations in the absence of anaemia

Ralapanawa, Dissanayake Mudiyanselage Priyantha Udaya Kumara; Jayawickreme, Kushalee Poornima; Ekanayake, Ekanayake Mudiyanselage Madhushanka; Jayalath, Widana Arachchilage Thilak Ananda

doi:10.1186/s13104-015-1437-9

Cited by 40 publications

(31 citation statements)

References 14 publications

(18 reference statements)

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“…Also the increase of MCV and RDW, associated with the lack of Cbl, leads to the increased cardiovascular risk [128,129]. Neurological manifestations of vitamin deficiency can also occur in the absence of anemia [130]. If the repletion comes late, the myelin degeneration caused by deficiency can also be irreversible [131].…”

Section: Status Among Vegetariansmentioning

confidence: 99%

“…The folate trap can mask a possible silent functional deficiency of folic acid, even with high folate serum concentration [146]. The vegetarian diet, rich in folacin, may mask hematological symptoms, so Cbl deficiency may only be evident due to neurological signs in the late stages, such as neuropsychiatric abnormalities, neuropathy, dementia and, albeit rarely, atrophy of optic nerves [85,130]. Usually hematologic manifestations and anemia precede neurologic signs, which are more severe and mostly irreversible [147,148].…”

Section: Supplementation and Fortificationmentioning

confidence: 99%

“…Usually hematologic manifestations and anemia precede neurologic signs, which are more severe and mostly irreversible [147,148]. The response to treatment is inversely proportional to the severity of the deficiency state and to the latency of intervention [130]. Cbl used in fortified foodstuffs and in supplements is in crystalline form.…”

Section: Supplementation and Fortificationmentioning

confidence: 99%

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Vitamin B12 among Vegetarians: Status, Assessment and Supplementation

Rizzo¹,

et al. 2016

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Cobalamin is an essential molecule for humans. It acts as a cofactor in one-carbon transfers through methylation and molecular rearrangement. These functions take place in fatty acid, amino acid and nucleic acid metabolic pathways. The deficiency of vitamin B12 is clinically manifested in the blood and nervous system where the cobalamin plays a key role in cell replication and in fatty acid metabolism. Hypovitaminosis arises from inadequate absorption, from genetic defects that alter transport through the body, or from inadequate intake as a result of diet. With the growing adoption of vegetarian eating styles in Western countries, there is growing focus on whether diets that exclude animal foods are adequate. Since food availability in these countries is not a problem, and therefore plant foods are sufficiently adequate, the most delicate issue remains the contribution of cobalamin, which is poorly represented in plants. In this review, we will discuss the status of vitamin B12 among vegetarians, the diagnostic markers for the detection of cobalamin deficiency and appropriate sources for sufficient intake, through the description of the features and functions of vitamin B12 and its absorption mechanism.

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Section: Status Among Vegetariansmentioning

confidence: 99%

Section: Supplementation and Fortificationmentioning

confidence: 99%

Section: Supplementation and Fortificationmentioning

confidence: 99%

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Vitamin B12 among Vegetarians: Status, Assessment and Supplementation

Rizzo¹,

et al. 2016

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“…The same study also noted that there was a significantly higher incidence of the anti-IF antibodies among women compared to men. [10] It is equally interesting that the neurologic features were initially more prominent than the anaemia. This may have been due to attempts to correct anaemia with oral hematinics including folate, which would not correct the neurologic features.…”

Section: Discussionmentioning

confidence: 99%

Demyelinating lesions as a presenting feature of pernicious anaemia: Case report and literature review

Daimari

Oyekunle

Ocampo

et al. 2017

CRIM

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Background: Pernicious anaemia (PA) describes megaloblastic anaemia resulting from cobalamin deficiency that is due to the absence of intrinsic factor (IF). Most cases are autoimmune in origin, with antibodies to parietal cells, IF or the cobalamin -IF complex. Methods: We report the clinical features, investigation and treatment of a patient in whom the first presentation of PA was demyelinating brain lesions. The patient presented with clinical features initially of neurological impairment and subsequently anaemia. Imaging studies were consistent with demyelinating lesions extending from the cortex to the midbrain. Peripheral blood and bone marrow findings were consistent with megaloblastic anaemia, which were confirmed by subnormal serum cobalamin levels. The patient was treated with parenteral cobalamin and oral folic acid. Results: The patient responded with complete resolution of anaemia and complete clinical neurological response. Conclusion: Clinical, laboratory and radiologic findings are important in the screening of patients presenting with demyelinating lesions, as these may help in the diagnosis of rare cases of PA. These tests are just as relevant even in the young African female population.

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“…More importantly, they are essential for skin and muscles health (9). Given all mentioned treatments and low success rate in identifying proper treatment methods to reduce the incidence of RAS, it was decided to assess the effects of injecting the B group containing high-dose of B vitamins (as there have been cases of treatment of diseases or reducing their symptoms with prescribing dose higher than the recommended daily intake of these vitamins) (10) on aphthous lesions and compare it with oral form of vitamins and nutritional factors, including folic acid, chewable vitamin C, iron tablet, and B complex vitamin.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Effect of Injectable Vitamin B With Conventional Oral Treatment on Aphthous Stomatitis

et al. 2017

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Background: Recurrent aphthous stomatitis (RAS) is a common condition with recurrent ulcerations limited to the oral mucosa. Different predisposing factors have been proposed, including iron, vitamin B12, and folic acid deficiencies. The aim of this study was to evaluate the effect of injectable vitamin B in comparison with a form of oral therapy on recurrent Aphthous stomatitis. Methods: This randomized clinical trial was performed on 60 patients with RAS, during years 2015 and 2017. All patients were at least 18 years of age without systemic disease associated with RAS. All the study population had a minor type of Aphthous ulcers with two months of maximum recurrence intervals during the last year. Additionally, all patients benefited from a checklist, including demographic data and relapse intervals, and a number of lesions were completed before the start of the study. Also, blood tests were performed to evaluate a complete counting of blood cells, and levels of ferritin, vitamin B12, and folic acid. Next, patients were randomly divided to two groups comprised of those that received eight weeks of injectable vitamin B (a combination of B1, B6, and B12) and those on eight weeks of chewable tablets (a combination of iron, folic acid, vitamin B complex, and vitamin C). Finally, all patients were monitored for 10 months. Results: There were no statistically significant differences between the two groups in terms of deficiencies in ferritin, vitamin B12, and folic acid (P > 0.05). In the injectable form of treatment, the efficacy was excellent in 14, moderate in 12, and low in four patients while in the oral form, the efficacy was moderate in nine and low in 12 patients. It is important to consider that there was no response to treatment in nine patients. Conclusions:The injectable form of Vitamins B that contains a high dose of vitamin B had better efficacy than the oral form. Accordingly, it can be concluded that the injectable form of vitamin B might be an effective treatment as it is considered a simple, inexpensive, and low-risk treatment for patients with RAS, regardless of ferritin, vitamin B12, and folic acid levels.

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B12 deficiency with neurological manifestations in the absence of anaemia

Cited by 40 publications

References 14 publications

Vitamin B12 among Vegetarians: Status, Assessment and Supplementation

Vitamin B12 among Vegetarians: Status, Assessment and Supplementation

Demyelinating lesions as a presenting feature of pernicious anaemia: Case report and literature review

Comparing the Effect of Injectable Vitamin B With Conventional Oral Treatment on Aphthous Stomatitis

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