To date, the determination of serum vitamin B12 levels has been the most common laboratory test for the assessment of vitamin B12 status; however, the diagnostic accuracy of this test is low. To obtain a more sensitive marker, a new test to measure holotranscobalamin (holoTC) levels has been introduced. In this study, we assessed 45 patients for whom a vitamin B12 test had been requested and 139 anemic patients. We investigated the associations between the levels of homocysteine (Hcy) and those of holoTC, serum vitamin B12, and folate and assessed the diagnostic value of holoTC levels as a marker for vitamin B12 deficiency. We also determined the precision of the AxSYM holoTC assay by calculating the coefficient of variance (CV). The within-run and between-run precision values were excellent, as all CV values were less than 3.5%. The holoTC levels were low (<35 pmol/L) in 7 samples, and 6 of these samples had normal total serum vitamin B12 levels. In 2 of these samples, high Hcy levels (>12 micromol/L) indicated vitamin B12 deficiency. Thus, the holoTC levels were more sensitive than the serum vitamin B12 levels for indicating vitamin B12 status. If the serum vitamin B12 level is 151-300 pmol/L, the levels of holoTC alone or in combination with serum vitamin B12 levels are likely to be more useful markers than serum vitamin B12 levels alone.
Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Biological Markers/blood ; Female ; Folic Acid/blood ; Homocysteine/blood ; Humans ; Male ; Middle Aged ; Transcobalamins/*analysis ; Vitamin B 12/*blood ; Vitamin B 12 Deficiency/diagnosis ; Young Adult

PURPOSE: Subacute combined degeneration (SCD) involves progressive degeneration of the spinal cord, optic nerve, and peripheral nerves. Vitamin B12 (VB12) is a co-factor in myelin synthesis. Because each cell that constitutes the myelin component in the central nervous system and peripheral nervous system is different, it is improbable that these cells undergo simultaneous degeneration. However, the sequence of degeneration in SCD has not been established. MATERIALS AND METHODS: In this study, we analysed medical records and electrophysiological data of patients who showed neurological symptoms and whose serum VB12 levels were lower than 200 pg/mL. RESULTS: We enrolled 49 patients in this study. Their mean VB12 level was 68.3 pg/mL. Somatosensory evoked potential (SEP) study showed abnormal findings in 38 patients. Of the 40 patients who underwent visual evoked potential (VEP) study, 14 showed abnormal responses. Eighteen patients showed abnormal findings on a nerve conduction study (NCS). In this study, abnormal posterior tibial nerve SEPs only were seen in 16 patients, median nerve SEPs only were seen in 3 patients, abnormal VEPs only in two, and abnormal NCS responses in one patient. No patient complained of cognitive symptoms. CONCLUSION: In SCD, degeneration appears to progress in the following order: lower spinal cord, cervical spinal cord, peripheral nerve/optic nerve, and finally, the brain.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Evoked Potentials, Somatosensory/physiology ; Female ; Humans ; Male ; Middle Aged ; Subacute Combined Degeneration/*blood/metabolism/*physiopathology ; Vitamin B 12/blood ; Vitamin B 12 Deficiency/blood/complications ; Young Adult

The administration of nitrous oxide can cause bone marrow depression like that aasociated with vitamin B12 defieiency and hematologic abnormalities. We investigated whether the addition of nitrous oxide for up to 4 hours to isoflurane anesthesia causes injury to 40 healthy laminectomy patients. In each patient, serum vitamin B12, folate and hematologic parameters (RBC, Hb, MCV, MCHC, WBC, platelet, reticulocyte, neutrophil) were measured on preinduction and postoperative 1st, 3rd, 5th, 7th day. Fourty patients divided into two groups randomly. In group 1 (n=20), 100% oxygen plus 1.0-2.0 vol% isoflurane was given; Group 2 (n=20), 50 % nitrous oxide, oxygen plus 1.0-2.0 vol% isoflurane was given. The results were as follows; 1) Comparing with the serum vitamin B12 and folate in both groups, there were no statistical signifieant changes between two groups until postoper- ative 7th day. 2) Nitrous oxide using 4 hours didn't influence on the hematologic parame ters until postoperative 7th day. This study suggests that the administration of nitrous oxide for up to 4 hours didnt influence on serum vitamin B12, folate and hematologic parameters until postoperative 7th day. But further studies may be necessary for more prolonged anesthetic time and methods regarding nitrous oxide.
Anesthesia ; Blood Platelets ; Bone Marrow ; Depression ; Folic Acid* ; Hematopoiesis* ; Humans ; Isoflurane ; Laminectomy ; Nitrous Oxide* ; Oxygen ; Reticulocytes ; Vitamin B 12* ; Vitamins*

The anemia still remains the most common hematologic disorder in the world despite improvements in general health and nutrition. Recently, the prevalence of anemia in the persons affected leprosy aged over 60 years was reported 22.4% in 60-69 years and 47.4% in 70 years or older in male and was reported 33.8% in 60-69 years and 46.0% in 70 years or older in female. This study was aimed at assessing the causes of anemia in the persons affected leprosy aged over 60 years. For evaluation of anemia, including prevalence, typing, and cause, hemoglobin, MCV(mean corpucular volume), RDW(red blood cell distribution width), ferritin, iron, TIBC, reticulocyte count, serum vitamin B12, serum folate and etc were checked. The proportion of the anemia classified by MCV was 6.6%(microcytic), 63.2%(normocytic), and 30.3%(macrocytic) and a half of the anemia was attributed to chronic diseases, 14.5% to anemia of iron deficiencies, 5.3% to anemia of nutrient(vitamin B12 & folate) deficiencies, 3.9% to anemia of hemolysis, and a quarter(27.6%) was "unexplained". We will consider about the evaluation of more detailed causes of anemia in persons affected leprosy, and management plan for anemia in them by the in-depth studies.
Anemia* ; Blood Cells ; Chronic Disease ; Female ; Ferritins ; Folic Acid ; Hemolysis ; Humans ; Iron ; Leprosy* ; Male ; Prevalence ; Reticulocyte Count ; Vitamin B 12

<b>OBJECTIVEb>To summarize the clinical characteristics, diagnosis and treatment of a case with autoimmune lymphoproliferative syndrome (ALPS) .

<b>METHODb>The patient was diagnosed as autoimmune lymphoproliferactive syndrome (ALPS) after being admitted to the Department of Rheumatism and Immunology of Tianjin Children's Hospital in February 20, 2014. The clinical characteristics, physical examination, laboratory tests, gene tests, and treatment process were analyzed and related literature was reviewed.

<b>RESULTb>The patient was a 16-month- old boy.Since the first month of life, he started to have repeatedly fever, diarrhea, shortness of breath, lymphadenopathy, hepatosplenomegaly, anemia (HGBmin 50 g/L) and thrombocytopenia (min 35 × 10⁹/L) . But multiple exams showed a normal peripheral blood leukocyte count, hypergammaglobulinemia (IgG 19 800 mg/L, IgA 1 710 mg/L, IgM 2 590 mg/L) and significantly increased serum vitamin B12. Flow cytometric measures showed that CD3⁺ CD4⁻ CD8⁻ T lymphocytes significantly increased ( > 10%) at four times. The count of CD3⁺ TCRαβ⁺ CD4⁻ CD8⁻T lymphocytes (double negative T cells; DNTs) >3% twice. The genetic test showed that 309th FAS gene area showed heterozygous mutations, the boy was diagnosed as ALPS. Added examinations of lymphocytes apoptosis induced by FAS was positive. He was treated with prednisone 15 mg once daily and immunomodulator 150 mg three times a day, while in maintaining period with normal levels of hemoglobin and platelet, the dose of prednisone was reduced gradually. Till now, the patient has been treated and observed for 8 months. We retrieved the reports of ALPS in the databases at home and abroad published in recent 10 years, more than 400 cases reported from foreign countries, but there were only 5 domestic cases. Among those, 4 had onset in infancy and 1 at 6-years of age. All the cases presented servere lymphadenopathy and hepatosplenomegaly with anemia (4 of them with hemolytic anemia) and thrombocytopenia. Three cases had a history of frequent infection, one of them had glomerulonephritis. All patient with significant high level of serum immunoglobulin ( > 1.5 times upper limit of normal range), in 3 of them serum vitamin B12 was > 1.5 pg/L (the other 2 cases missed the exam). In 5 cases CD3⁺ CD4⁻ CD8⁻T cells > 10%, and in 2 case DNTs were 8.9% and 15.7% respectively (the other 3 cases missed the exam). Three cases were clearly detected with FAS mutations. All patients were treated with corticosteroid, 2 of them were added with mycophenolate mofetil. The therapy presented effective result in early 1-3 months, but no long-term follow-up reports were available.

<b>CONCLUSIONb>ALPS is a disorder of disrupted lymphocyte homeostasis caused by defective Fas-mediated apoptosis, and it is one of the primary immunodeficiency diseases. The onset of the disease occurs during infancy mainly. Clinical lymphoid hyperplasia and autoimmune phenomena are outstanding signs, which can be associated with frequent infections and allergies. The level of serum vitamin B12 > 1.5 pg/L and the count of CD3⁺ CD4⁻ CD8⁻ T cell show important significance. Exact diagnosis should depend on detecting DNTs and FAS gene.

Autoimmune Lymphoproliferative Syndrome ; diagnosis ; therapy ; Cell Count ; Humans ; Infant ; Male ; T-Lymphocyte Subsets ; Vitamin B 12 ; blood ; fas Receptor

OBJECTIVES: Even though several epidemiological studies have observed positive associations between blood lead levels and homocysteine, no study has examined whether this association differs by the levels of micronutrients, such as folate, vitamin B6, and vitamin B12, which are involved in the metabolism of homocysteine. In this study, we examined the interactions between micronutrients and blood lead on homocysteine levels. METHODS: This study was performed with 4089 adults aged > or =20 years old in the US general population using the National Health and Nutrition Examination Survey 2003-2004. RESULTS: There were significant or marginally significant interactions between micronutrients and blood lead levels on mean homocysteine levels. Positive associations between blood lead and homocysteine were clearly observed among subjects with low levels of folate or low vitamin B6 (p-trend <0.01, respectively). However, in the case of vitamin B12, there was a stronger positive association between blood lead and homocysteine among subjects with high levels of vitamin B12, compared to those with low levels of vitamin B12. In fact, the levels of homocysteine were already high among subjects low in vitamin B12, irrespective of blood lead levels. When we used hyperhomocysteinemia (homocysteine>15 micromol/L) as the outcome, there were similar patterns of interaction, though p-values for each interaction failed to reach statistical significance. CONCLUSIONS: In the current study, the association between blood lead and homocysteine differed based on the levels of folate, vitamin B6, or vitamin B12 present in the blood. It may be important to keep sufficient levels of these micronutrients to prevent the possible harmful effects of lead exposure on homocysteine levels.
Adult ; Aged ; Female ; Folic Acid/blood ; Homocysteine/*blood ; Humans ; Lead/*blood ; Male ; Micronutrients/*blood ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; United States ; Vitamin B 12/blood ; Vitamin B 6/blood

<b>OBJECTIVEb>To explore the levels of serum vitamin B(12) (VB(12)) in preschool children, determine the relationship between the levels of serum VB(12) and anemia, and analyze the effects of several factors related to the level of serum VB(12).

<b>METHODSb>From March 2005 to July 2005, the weight, height and complete blood count (CBC) were studied in 351 children aged 2 to 7 years from 4 kindergartens of Chongqing. The concentrations of serum VB(12) and the dietary survey of 177 of the children were evaluated.

<b>RESULTSb>The average level of serum VB(12) for the preschool children was 552 pg/ml. The levels of serum VB(12) in 4.5% (8/177) of the children were below 200 pg/ml (defined as VB(12) deficiency), in 10.7% (19/177) of the children were 200 - 300 pg/ml (called marginal deficiency). There were no significant differences in the levels of serum VB(12) between boys and girls. And there was no correlation between the levels of serum VB(12) and hemoglobin. The results of multivariate stepwise regression analysis showed that the concentrations of serum VB(12) were mainly influenced by the contents of VB(12) in the foods (P = 0.03). Eight of the children with normal growth and development were diagnosed as VB(12) deficiency, only one of them was diagnosed microcytic hypochromatic anemia. The ranges of Hb, MCV and MHC were normal in the other 7 children.

<b>CONCLUSIONSb>The levels of serum VB(12) of preschool children were higher than that of adults, suggesting that the levels of serum VB(12) change with age. There were no significant differences in the levels of serum VB(12) in 2-7 years old children between sex and ages. The levels of serum VB(12) were not correlated with the concentrations of hemoglobin. Macrocytic anemia may not occur in preschool children with VB(12) deficiency. The intake of VB(12) from the diets was one of the important factors for preschool children to keep the normal ranges of serum VB(12). It is beneficial for children to consume foods enriched with VB(12) to keep the normal level of serum VB(12).

Adult ; Age Factors ; Anemia ; epidemiology ; Child ; Child Nutritional Physiological Phenomena ; Child, Preschool ; China ; epidemiology ; Diet Surveys ; Female ; Humans ; Male ; Multivariate Analysis ; Nutritional Status ; Regression Analysis ; Risk Factors ; Vitamin B 12 ; administration & dosage ; blood ; Vitamin B 12 Deficiency ; epidemiology

The association of vitiligo and pernicious anemia has been previously documented. The low levels of folic acid and vitamin B12 were thought to be related to vitiligo. To date, there have been very few reports about the serum levels of folic acid and vitamin B12 in patients with vitiligo. Using radioimmunoassay, we measured the serum levels of folic acid and vitamin B12 in 100 Korean patients with vitiligo. The mean serum levels of folic acid and vitamin B12 were 6.31 +/- 2.82 ng/ml and 630.25 +/- 230.94 pg/ml, respectively, in patients with vitiligo. These levels showed no significant difference compared to the normal control group, suggesting that folic acid and vitamin B12 do not appear to play a role in the pathogenesis of vitiligo.
Adolescence ; Adult ; Aging/blood ; Child ; Female ; Folic Acid/blood* ; Human ; Male ; Middle Age ; Sex Characteristics ; Vitamin B 12/blood* ; Vitiligo/blood*

<b>OBJECTIVEb>To investigate the clinical significance of plasmic homocysteine (Hcy), folate (FA) and Vitamin B(12) (VitB(12)) in patients with ulcerative colitis (UC).

<b>METHODSb>Plasmic Hcy in 112 cases of UC patients and 110 controls were detected by HPLC-FD method. Plasmic FA, VitB(12) in 76 cases of UC patients and 12 controls were detected by enzyme-linked immunosorbent assay (ELISA) method.

<b>RESULTSb>The level of plasmic Hcy in UC patients was(11.27±7.26) μmol/L, significantly higher than that in controls[(8.19±4.81) μmol/L, P<0.05], and was not significantly correlated with disease index, extent and duration of UC(P>0.05). The level of FA and VitB(12) in UC patients were (7.64±1.95) nmol/L and (108.64±32.22) pmol/L respectively, lower than those in controls[(9.14±1.23) nmol/L and (112.64±33.33) pmol/L, P<0.05]. The level of plasmic Hcy was negatively correlated with the level of FA and VitB(12) in UC patients(P<0.05). The level of plasmic FA decreased to some extent with UC disease duration.

<b>CONCLUSIONb>Plasmic Hcy is elevated in UC patients, which may be related to the decrease of FA and VitB(12).

Adolescent ; Adult ; Aged ; Case-Control Studies ; Colitis, Ulcerative ; blood ; Female ; Folic Acid ; blood ; Homocysteine ; blood ; Humans ; Male ; Middle Aged ; Vitamin B 12 ; blood ; Young Adult

Adult ; Amino Acid Metabolism, Inborn Errors ; blood ; diagnosis ; Bipolar Disorder ; blood ; diagnosis ; Gas Chromatography-Mass Spectrometry ; Humans ; Hyperhomocysteinemia ; blood ; diagnosis ; Male ; Tandem Mass Spectrometry ; Vitamin B 12 ; blood