Clinical and haematological screening in recurrent aphthae

Abstract

Summary A series of 328 consecutive out-patients with recurrent aphthae were screened for deficiencies of iron, folic acid and vitamin B12, by examination of the peripheral blood, by assays of serum vitamin B12 and corrected whole blood folate, and estimation of the serum iron and total iron binding capacity; deficiencies were demonstrated in 45 patients (13·7%). Of these, 31 were deficient in iron, 15 in folic acid and 11 in vitamin B12; 11 patients had combined deficiencies. Of the 45 aphthae patients with deficiencies, 29 had anaemia or demonstrable abnormalities in the red cell indices or stained blood film, and the essay results were confirmatory. In the remaining 16 patients, no red cell changes were present, and diagnosis depended entirely on reduced levels of serum vitamin B12, whole blood folate or iron saturation of transferrin; such latent deficiencies occurred only with iron and folic acid, whereas all patients with vitamin B12 deficiency even without anaemia had morphological changes in the blood. Individual patients with a deficiency could not be distinguished from those without a deficiency on the basis of clinical examination of the mouth ulcers. However, aphthae patients who also had glossitis or angular cheilitis were more likely to suffer from such deficiencies. Thirty-nine of the deficient aphthae patients available for follow-up were assessed at least 6 months after appropriate replacement therapy; 23 showed a complete remission of ulcers, 11 were improved and 5 were not helped. It is suggested that the considerable incidence of deficiencies found in this series and the clinical and haematological response to replacement therapy confirms the need for full screening of patients with re-recurrent aphthae. Since 16 out of 45 of these patients had no anaemia or morphological abnormalities in the peripheral blood, their deficiencies would have been missed on routine haematological examination alone; for this reason it is recommended that screening should also include estimation of the serum iron and total iron-binding capacity, whole blood folate and, possibly vitamin B12.

Number VI Recurrent aphthous stomatitis

“…Haematinic (iron, folic acid or vitamin B 12 ) deficiencies may be twice as common in some groups of patients with RAS as in healthy control subjects (Wray et al , 1975; Challacombe et al , 1977a, 1983; Hutcheon et al , 1978; Tyldesley, 1983; Rogers and Hutton, 1986; Field et al , 1987; Porter et al , 1988). About 20% of patients with RAS may have a haematinic deficiency, although one US study did not report any haematinic problem (Olson et al , 1982).…”

“…RAS-like ulceration can occur in Behcet's disease, however patients with the latter have multisystem disease, particularly affecting (Mittal et al, 1985;Schreiner and Jorizzo, 1987;Arbesfeld and Kurban, 1988;Jankowski et al, 1992;Stratigos et al, 1992). Haematinic (iron, folic acid or vitamin B 12 ) deficiencies may be twice as common in some groups of patients with RAS as in healthy control subjects (Wray et al, 1975;Challacombe et al, 1977aChallacombe et al, , 1983Hutcheon et al, 1978;Tyldesley, 1983;Rogers and Hutton, 1986;Field et al, 1987;Porter et al, 1988). About 20% of patients with RAS may have a haematinic deficiency, although one US study did not report any haematinic problem (Olson et al, 1982).…”

Recurrent Aphthous Stomatitis

“…In several studies, hematinic (iron, folic acid, or vitamin B 1 2) deficiencies have been demonstrated to be twice as common in RAS patients than in controls (Wray et al, 1975;Challacombe et al, 1977aChallacombe et al, , 1983Hutcheon et al, 1978;Tyldesley, 1983;Rogers and Hutton, 1986;Field et al, 1987;Porter et al, 1988). About 20% of patients with RAS may have a hematinic deficiency, though one US study did not report any hematinic problem (Olsen et al, 1982).…”

A Clinical Study on Recurrent Aphthous Stomatitis : An Assessment of Multiple Etological Factors

“…Porter et al 20 in his study found that 5% of cases were having folic acid deficiency. Hutcheon et al 21 in his study evaluated 328 patients with RAS and he found hematological deficiencies in 45 patients (13.7%), of which 15(4.57%) were deficient in folic acid. The relation between folic acid and RAS is statically not significant (p=0.174).…”