Portal de Periódicos da CAPES

Hematological findings in patients with Food-Cobalamin malabsorption

2003; Elsevier BV; Volume: 115; Issue: 7 Linguagem: Inglês

10.1016/s0002-9343(03)00451-0

1555-7162

Emmanuel Andrès, Esther Noël, Frédéric Maloisel,

Child Nutrition and Feeding Issues

Food-cobalamin malabsorption is reported to be the leading etiology of cobalamin (vitamin B12) deficiency in adults (1Carmel R. Malabsorption of food-cobalamin.Baillières Clin Haematol. 1995; 8: 639-655Abstract Full Text PDF PubMed Scopus (164) Google Scholar), and the clinical importance of low cobalamin levels has been discussed (2Van Asselt D.Z. Blom H.J. Zuiderent R. et al.Clinical significance of low cobalamin levels in older hospital patients.Neth J Med. 2000; 57: 41-49Crossref PubMed Scopus (51) Google Scholar). We describe hematological findings in 103 patients with food-cobalamin malabsorption, as defined by Carmel (1Carmel R. Malabsorption of food-cobalamin.Baillières Clin Haematol. 1995; 8: 639-655Abstract Full Text PDF PubMed Scopus (164) Google Scholar). These patients were from an observational cohort study involving more than 160 consecutive patients with cobalamin deficiency that was conducted at the University Hospital of Strasbourg, France, from 1995 to 2003 (3Andrès E. Goichot B. Schlienger J.L. Food-cobalamin malabsorption a usual cause of vitamin B12 deficiency.Arch Intern Med. 2000; 160: 2061-2062Crossref PubMed Google Scholar). The median age of the patients was 69 years, and 20% were women. All patients had low serum vitamin B12 levels (<200 pg/mL), with a mean (± SD) value of 142 ± 66 pg/mL (range, 35 to 200 pg/mL). All patients had a normal Schilling test (Dicopac test; Amersham Healthcare, Birmingham, United Kingdom). Twenty-four percent of the patients (n = 25) had no hematological abnormalities. The mean hemoglobin level was 10.9 ± 3.2 g/dL (range, 3.2 to 15.9 g/dL); the mean erythrocyte cell count was 96.3 ± 10.4 fL (range, 55 to 140 fL); the mean leukocyte count was 6.7 ± 3.8 × 103/μL (range, 1.5 to 20 × 103/μL); and the mean platelet count was 198 ± 90 × 103/μL (range, 30 to 520 × 103/μL). Pancytopenia was observed in 6% of patients (n = 6). Twenty percent of patients (n = 21) had a hemoglobin level <10 g/dL and 5% (n = 5) had a level <5 g/dL. Three of these patients had severe life-threatening hemolytic anemia. Twelve percent of patients (n = 12) had a leukocyte count <4 × 103/μL and 8% had a platelet count <100 × 103/μL. Bone marrow examination (available in 36 patients) confirmed the diagnosis of cobalamin deficiency, with typical features of megaloblastic anemia observed in 80% of patients. Correction of serum cobalamin levels and hematological abnormalities was achieved equally well in more than 80% of patients treated with either intramuscular or oral crystalline cyanocobalamin (250 to 1000 μg/d), with a mean follow-up of 35 months. This study suggests that food-cobalamin malabsorption may be associated with several hematological abnormalities in at least 75% of patients. Moreover, these abnormalities are associated with serious or life-threatening clinical manifestations in at least 10% of patients, as we have previously reported (3Andrès E. Goichot B. Schlienger J.L. Food-cobalamin malabsorption a usual cause of vitamin B12 deficiency.Arch Intern Med. 2000; 160: 2061-2062Crossref PubMed Google Scholar). This study confirms our previous reports (4Andrès E. Kurtz J.E. Perrin A.E. et al.Oral cobalamin therapy for the treatment of patients with food-cobalamin malabsorption.Am J Med. 2001; 111: 126-129Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 5Andrès E. Kaltenbach G. Noel E. Noblet-Dick M. Perrin A.E. Short-term oral cobalamin therapy for food-related cobalamin malabsorption.Ann Pharmacother. 2003; 37: 301-302Crossref PubMed Google Scholar) that oral and parenteral cobalamin appear to be equally effective in correcting both cobalamin levels and hematological abnormalities in at least 80% of patients.