Erythrocyte Mean Cellular Volume and its Relation to Serum Homocysteine, Vitamin B12 and Folate

Abstract

Cobalamin (B12) and folate deficiency is related to both increased erythrocyte mean cellular volume (MCV) and raised serum total homocysteine (tHcy) values. Furthermore, there are indications that B12 and folate serum values do not represent the tissue status of the two vitamins exactly. Therefore, a direct relationship between MCV and tHcy, if demonstrated, could support the hypothesis that tHcy is a better indicator for the cited vitamin status than the serum levels of B12 and folate. We studied MCV, gamma glutamyl transferase (GGT), serum B12, folate and tHcy values in 200 hospitalized patients. There was a significant correlation of MCV with GGT (r = 0.266, P < 0.001) and with tHcy (r = 0.248, P < 0.001), but not with serum B12 and folate. Stepwise multiple linear regression with MCV as dependent and GGT, B12, folate and tHcy as independent variables, respectively, revealed significant associations of MCV with GGT (B = 2.18, 95% CI 0.95-3.42, P = 0.001) and tHcy (B = 3.33, 95% CI 1.26-5.39, P = 0.002). By removing tHcy from this model, serum B12 became a significant predictor of MCV (B = -1.70, 95% CI -3.25 to -0.15, P = 0.032). Serum folate was not significantly associated with MCV in multivariate analysis. In conclusion, the present study confirms indications that serum B12 and folate values lack clinical sensitivity and specificity in diagnosing vitamin deficiency states by showing MCV was better associated to tHcy, than to B12 or folate serum levels. This observation demonstrates that tHcy may be useful in diagnosing patients with B12 and/or folate deficiency.

Could an analysis of mean corpuscular volume help to improve risk stratification in non-anemic patients with acute myocardial infarction?

“…A direct mechanism would be associated with a hindered flow of larger, less flexible erythrocytes through microcirculation, which is a phenomenon that might contribute to myocardial ischemia [23,24]. Patients with high MCV commonly develop hyperhomocysteinemia [25], which is known to augment cardiovascular risk [26][27][28]. Moreover, high MCV is an independent prognosticator of impaired endothelial function measured via flow-mediated dilatation [8], which may be explained by disrupted erythrocyte antioxidative potential in macrocytes and an associated imbalance in global redox homeostasis of the organism [8].…”

Akut İskemik İnmede Mortalite ve Morbidite Belirteçleri

“…B12 ve/veya folat eksikliği DNA sentezi sırasında nükleer replikasyon ve hücre bölünme hızını yavaşlatır. Dolayısıyla eritrosit oluşumu sırasında kırmızı kan hücrelerinin normalden daha büyük üretilmesine yani megaloblastlara sebep olur (33,34,35). Bu da yüksek MCV değerleri anlamına gelir.…”

Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion

“…Blood vitamin measurements are established and simple to perform, but are increasingly considered to be neither sufficiently sensitive nor specific (2,(122)(123)(124)(125). There is limited consensus on reference limits and desirable concentrations (108,109 ).…”