Laboratory Evaluation for Vitamin B12 Deficiency: The Case for Cascade Testing

Berg, Richard L.; Shaw, George H.

doi:10.3121/cmr.2012.1112

Cited by 21 publications

(18 citation statements)

References 28 publications

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“…We think that laboratories should provide a hematologic cutoff value to expect anemia and macrocytosis and a different higher cutoff value for subtle or neurologic deficiency states. Cascade testing was proposed by some authors . We agree with cascade testing approach, but that approach did not define a distinct hematologic cutoff value.…”

Section: Discussionmentioning

confidence: 69%

“…Hematologic manifestations of cobalamin deficiency include anemia, macrocytosis, pancytopenia and neutrophil hypersegmentation [10][11][12][13][14]. The effect of cobalamin deficiency on hematopoiesis is documented in the literature [15,16], and the association between pernicious anemia and cobalamin deficiency is well known, but studies about hematologic response to B12 treatment is inconsistent [10,[17][18][19][20][21][22][23][24]. Some studies failed to demonstrate a significant hematologic response to cobalamin therapy [17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Vitamin B12 and folate deficiency: should we use a different cutoff value for hematologic disorders?

Toprak¹,

Yalcın²,

Çolak³

2013

Int J Lab Hematology

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Vitamin B12 and folate deficiency: should we use a different cutoff value for hematologic disorders?

Toprak¹,

Yalcın²,

Çolak³

2013

Int J Lab Hematology

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“…Prior sources have used varying serum cobalamin concentrations to initiate supplementation, as low‐normal cobalamin concentrations theoretically could have important clinical consequences, such as GI signs and weight loss . In people with borderline hypocobalaminemia (defined as near the lower limit of the reference range), cobalamin deficiency remains possible, and additional testing through MMA and homocysteine concentrations is warranted, as cobalamin concentrations can fluctuate at different time points and tissue stores may not correlate well with serum cobalamin concentrations …”

Section: Discussionmentioning

confidence: 99%

Relationship between cobalamin and folate deficiencies and anemia in dogs

Appleman

Schlag²,

Siegel

2018

Veterinary Internal Medicne

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BackgroundMegaloblastic, nonregenerative anemia is a well‐known consequence of cobalamin or folate deficiencies in humans but is not recognized in hypocobalaminemic or hypofolatemic dogs. Establishment of relationships between hypocobalaminemia or hypofolatemia and hematologic disease would encourage vitamin B testing, and potentially supplementation, in anemic dogs.ObjectivesTo determine the prevalence of anemia in hypocobalaminemic or hypofolatemic dogs and to report the prevalence of hypocobalaminemia and hypofolatemia and nonregenerative anemia, macrocytosis, and anisocytosis in anemic dogs.AnimalsOne hundred and fourteen client‐owned dogs with known serum cobalamin and folate concentrations and CBCs and 42 client‐owned anemic dogs.MethodsRetrospective comparison of anemia prevalence in hypocobalaminemic or hypofolatemic and normocobalaminemic or normofolatemic dogs was performed. Prospective measurement of erythrocyte variables and cobalamin and folate concentrations in anemic dogs was carried out; relationships among hypocobalaminemia and regenerative status, mean corpuscular volume, and red cell distribution width were evaluated.ResultsSignificant differences in prevalence of anemia between hypocobalaminemic (36%) and normocobalaminemic dogs (26%; P = .23) or between hypofolatemic (31%) and normofolatemic dogs (30%; P = .99) were not detected. Between hypocobalaminemic and normocobalaminemic dogs, no significant differences in prevalence of nonregenerative anemia (69% vs 63%; P = .65), macrocytosis (17% vs 0%; P = .53), or anisocytosis (28% vs 0%; P = .14) were detected. Anemic dogs had high prevalence of vitamin B deficiencies (nonregenerative: 64% hypocobalaminemic, 18% hypofolatemic; regenerative: 57% hypocobalaminemic, 21% hypofolatemic).Conclusions and Clinical ImportanceThe association between cobalamin and folate deficiencies and macrocytic, nonregenerative anemia established in humans is not routinely present in dogs.

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“…9,20,21 Second, we could not retrieve iron status, methylmalonic acid levels, MTHFR C677T polymorphism and, as discussed above, exact data on fluid management, and transfusion, which could have confounded our findings. 21,22 Third, we did not investigate for deteriorated function of leukocytes and thrombocytes associated with nitrous oxide exposure, which would possibly translate to outcomes such as infection or thrombosis. 18 …”

Section: Discussionmentioning

confidence: 99%

The Hematological Effects of Nitrous Oxide Anesthesia in Pediatric Patients

Duma¹,

Cartmill

Blood

et al. 2015

Anesthesia &Amp; Analgesia

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Background Prolonged administration of nitrous oxide causes an increase in plasma homocysteine in children via vitamin B12 inactivation. However, it is unclear if nitrous oxide doses used in clinical practice cause adverse hematological effects in pediatric patients. Methods This retrospective study included 54 pediatric patients undergoing elective spinal surgery: 41 received nitrous oxide throughout anesthesia (maintenance group), 9 received nitrous oxide for induction and/or emergence (induction/emergence group), and 4 did not receive nitrous oxide (nitrous oxide-free group). Complete blood counts obtained before and up to 4 days after surgery were assessed for anemia, macro-/microcytosis, anisocytosis, hyper-/hypochromatosis, thrombocytopenia and leucopenia. The change (Δ) from preoperative to the highest postoperative value was calculated for mean corpuscular volume (MCV) and red cell distribution width (RDW). Results No pancytopenia was present in any patient after surgery. All patients had postoperative anemia; none had macrocytosis. Postoperative MCV (mean [99% CI]) peaked at 86 [85 to 88] fL, 85 [81 to 89] fL, and 88 [80 to 96] fL, and postoperative RDW at 13.2 [12.8 to 13.5] %, 13.3 [12.7 to 13.8] %, and 13.0 [11.4 to 14.6] % for the maintenance group, the induction/emergence group, and the nitrous oxide-free group. Two patients in the maintenance group (5 %) developed anisocytosis (RDW>14.6%), but none in the induction/emergence group or in the nitrous oxide-free group (P = 0.43). Both ΔMCV (P=0.52) and ΔRDW (P=0.16) were similar across all groups. Conclusions Nitrous oxide exposure for up to eight hours is not associated with megaloblastic anemia in pediatric patients undergoing major spinal surgery.

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Laboratory Evaluation for Vitamin B12 Deficiency: The Case for Cascade Testing

Cited by 21 publications

References 28 publications

Vitamin B12 and folate deficiency: should we use a different cutoff value for hematologic disorders?

Vitamin B12 and folate deficiency: should we use a different cutoff value for hematologic disorders?

Relationship between cobalamin and folate deficiencies and anemia in dogs

The Hematological Effects of Nitrous Oxide Anesthesia in Pediatric Patients

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