What should I know before ordering a bone marrow aspiration/biopsy in patients with vitamin B<sub>12</sub>deficiency?

Randhawa, Jaskirat; Ondrejka, Sarah L.; Setrakian, Sebouh; Taylor, H. Grant

doi:10.1136/bcr-2013-010200

Cited by 15 publications

(16 citation statements)

References 9 publications

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“…On the other hand, a low white blood cell count may also be an indication of an impaired immune system or abnormal bone marrow pathology (57). Vitamin B-12 deficiency is a reversible cause of bone marrow failure (58), and some case reports have suggested a link between vitamin B-12 deficiency (more likely in vegetarians and vegans) and pancytopenia (low counts of red blood cells, white blood cells, and platelets) (59, 60). Differences in intake of other nutrients between the diet groups might also explain the differences in white blood cell count.…”

Section: Discussionmentioning

confidence: 99%

Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank

Tong

Key

Gaitskell

et al. 2019

The American Journal of Clinical Nutrition

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BackgroundThere may be differences in hematological parameters between meat-eaters and vegetarians.ObjectiveThe aim of this study was to perform cross-sectional analyses of hematological parameters by diet group in a large cohort in the United Kingdom.MethodsA complete blood count was carried out in all UK Biobank participants at recruitment (2006–2010). We examined hemoglobin, red and white blood cell counts, and platelet counts and volume in regular meat eaters (>3 times/wk of red/processed meat consumption, n = 212,831), low meat eaters (n = 213,092), poultry eaters (n = 4815), fish eaters (n = 10,042), vegetarians (n = 6548), and vegans (n = 398) of white ethnicity and meat eaters (n = 3875) and vegetarians (n = 1362) of British Indian ethnicity.ResultsIn both white and British Indian populations, compared with regular meat eaters (or meat eaters in Indians), the other diet groups had up to 3.7% lower age-adjusted hemoglobin concentrations (difference not significant in white vegan women) and were generally more likely to have anemia (e.g., 8.7% of regular meat eaters compared with 12.8% of vegetarians in white premenopausal women; P < 0.05 after Bonferroni correction). In the white population, compared with regular meat eaters, all other diet groups had lower age- and sex-adjusted total white cells, neutrophils, lymphocytes, monocytes, and eosinophils (P-heterogeneity < 0.001 for all), but basophil counts were similar across diet groups; in British Indians, there was no significant difference in any of the white blood cell counts by diet group. Compared with white regular meat eaters, the low meat eaters, poultry eaters, fish eaters, and vegans had significantly lower platelet counts and higher platelet volume, whereas vegetarians had higher counts and lower volume. Compared with British Indian meat eaters, vegetarians had higher platelet count and lower volume.ConclusionsIn the UK Biobank, people with low or no red meat intake generally had lower hemoglobin concentrations and were slightly more likely to be anemic. The lower white blood cell counts observed in low and non-meat eaters, and differences in mean platelet counts and volume between diet groups, warrant further investigation. This observational study was registered at http://www.isrctn.com/ as ISRCTN10125697.

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Section: Discussionmentioning

confidence: 99%

Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank

Tong

Key

Gaitskell

et al. 2019

The American Journal of Clinical Nutrition

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“…Cases have been previously reported of having a classical presentation of B12 deficiency (macrocytic anemia, low B12 on labs, neurological symptoms, and hypersegmented neutrophils) who still underwent a bone marrow biopsy [3]. The case described herein demonstrates that B12 deficiency can also present without the classical symptoms, further complicating the clinical picture.…”

Section: Discussionmentioning

confidence: 80%

“…Clinicians may order a bone marrow biopsy on patients with pancytopenia to rule out malignancies [1,3]. However, this case highlights that the evaluation of a bone marrow biopsy without considering secondary causes of pancytopenia in their differential diagnosis may complicate the scenario.…”

Section: Discussionmentioning

confidence: 99%

Pernicious anemia: a myelodysplastic syndrome look-alike

Kesbeh

Pakbaz

2019

Journal of Community Hospital Internal Medicine Perspectives

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Severe cytopenias (anemia, thrombocytopenia, neutropenia or any combination of these) are common causes of ER visits and hospital admissions. In adults, the etiology of cytopenias has a broad differential diagnosis including vitamin and mineral deficiencies, autoimmune conditions, infections, bone marrow failure disorders, or malignancies. We present a case of severe anemia and thrombocytopenia who was initially diagnosed with myelodysplastic syndrome (MDS) based on the results of a bone marrow biopsy. However, subsequent workup revealed that she had B12 deficiency secondary to pernicious anemia. This case highlights how performing a bone marrow biopsy without investigating secondary causes of cytopenia and bone marrow dysplasia can lead to a false diagnosis of MDS. Confirmation of the appropriate diagnosis spared the patient emotional trauma and unnecessary treatment with hypomethylating agents.

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“…Ineffective erythropoiesis can lead to pancytopenia, but the morphological bone marrow picture may mimic that of MDS. (12) For this reason, bone marrow aspiration/biopsy before a therapeutic trial with vitamin B 12 is not indicated. (12) Severe vitamin B 12 deficiency, if accompanied by folic acid deficiency, can present with transient chromosomal abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…(12) For this reason, bone marrow aspiration/biopsy before a therapeutic trial with vitamin B 12 is not indicated. (12) Severe vitamin B 12 deficiency, if accompanied by folic acid deficiency, can present with transient chromosomal abnormalities. (13) M. Wollan et al described a pediatric patient who, due to combined deficiency of the folic acid and vitamin B 12 , developed nonrandom del(7q), a clonal abnormality usually associated with MDS or secondary AML.…”

Section: Discussionmentioning

confidence: 99%

Bactrim Induced Hemolysis and Thrombocytopenia in a Patient with Pernicious Anemia

Ukudeyeva¹,

Nassereddin²,

Banerjee³

et al. 2017

IJBM

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What should I know before ordering a bone marrow aspiration/biopsy in patients with vitamin B₁₂deficiency?

Cited by 15 publications

References 9 publications

Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank

Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank

Pernicious anemia: a myelodysplastic syndrome look-alike

Bactrim Induced Hemolysis and Thrombocytopenia in a Patient with Pernicious Anemia

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What should I know before ordering a bone marrow aspiration/biopsy in patients with vitamin B12deficiency?

Cited by 15 publications

References 9 publications

Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank

Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank

Pernicious anemia: a myelodysplastic syndrome look-alike

Bactrim Induced Hemolysis and Thrombocytopenia in a Patient with Pernicious Anemia

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Product

Resources

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What should I know before ordering a bone marrow aspiration/biopsy in patients with vitamin B₁₂deficiency?