REASSESSING THE ROLE OF HOMOCYSTEINE AND HOLOTRANSCOBALAMIN LEVELS IN DIAGNOSING VITAMIN B12 DEFICIENCY ANEMIA

SHWETA TRIPATHI; NIRAJ CHOUREY; HIREMATH RN; MODI; SINHA DK

doi:10.22159/ajpcr.2022.v15i3.43997

Authors

SHWETA TRIPATHI Department of Medicine, Rama Medical College, Kanpur, Uttar Pradesh, India.
NIRAJ CHOUREY Department of Medicine, Choithram Hospital, Indore, Madhya Pradesh, India.
HIREMATH RN Department of Medicine, Choithram Hospital, Indore, Madhya Pradesh, India.
MODI Department of Medicine, Choithram Hospital, Indore, Madhya Pradesh, India.
SINHA DK Department of Medicine, Rama Medical College, Kanpur, Uttar Pradesh, India.

DOI:

https://doi.org/10.22159/ajpcr.2022.v15i3.43997

Keywords:

HOMOCYSTEINE, HOLO-TRANSCOBALAMIN, VITAMIN B12 DEFICIENCY ANAEMIA

Abstract

Background: Vitamin B12 deficiency can lead to irreversible neurological damage, megaloblastic anemia, osteoporosis, cerebrovascular, and cardiovascular diseases, and thus, early diagnosis is essential.

Objective: The objective of the study was to assess homocysteine (Hcy) and holotranscobalamine (HoloTC) levels among patients with Vitamin B12 deficiency and to see if Hcy and HoloTC level assay can help us in diagnosis of Vitamin B12 deficiency.

Methods: We carried out a cross-sectional observational study on 60 patients of Sr. B12 deficient male and female patients between the ages of 18 and 65 years in IPD and OPD patients at multispecialty hospital. Data were collected from predefined pro forma and were asked about their diet, socioeconomic status, and history. Then, these patients further undergone anthropometric measurements and investigated for Hcy and HoloTC level. The statistical analysis was done using Statistical Package for the Social Sciences (SSPS) software (version 11).

Results: About 60% of cases were vegetarian and 40% of cases were non-vegetarian. Mean age of study participants was 43.67 years, mean of mean cellular volume was 90.7 fl, mean of B12 was 138 pmol/L, mean of HoloTC was 60.84 pmol/L, and mean of Hcy was 34.17 umol/L. Out of 60 patients, 10 patients had anemia, 21 patients had neurological manifestation, and 29 patients had gastrointestinal (GI) manifestation. In male group, out of 32, 11 patients had HoloTC <8.9, 19 patients had value between 8.9 and 128, and two patients had HoloTC more than 128. In female group, out of 28, seven patients had HoloTC <8.9, 14 patients had value between 8.9 and 128, and seven patients had HoloTC >128. In group of 32 male patients, none of male patients showed Hcy value <5.9, four patients showed Hcy between 5.9 and 16, and 28 patients showed Hcy value >16. Out of 28 female patients, none of female patients showed Hcy <3.36, nine patients showed Hcy between 3.36 and 20.4, and 19 patients showed Hcy >20.4. p <0.001 is highly statistically significant.

Conclusion: In our study, we found that 31.33% of cases also showed decreased HoloTC along with B12 deficiency, but this correlation was statistically insignificant. We also found that 78.33% of cases showed increased Hcy along with serum B12 deficiency, which was statistically significant, so we concluded that there is a strong association between serum B12 and Hcy. We found that all patients with elevated Hcy also had low HoloTC except in two cases, but this correlation was not found to be statistically significant.

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References

Healton EB, Savage DG, Brust JC, Garrett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine 1991;70:229-45.

Smith AD, Refsum H. Vitamin B-12 and cognition in the elderly. Am J Clin Nutr 2009;89:707S-11S.

Kim GS, Kim CH, Park JY, Lee KU, Park CS. Effects of vitamin B12 on cell proliferation and cellular alkaline phosphatase activity in human bone marrow stromal osteoprogenitor cells and UMR106 osteoblastic cells. Metabolism 1996;45:1443-6.

Chambers JC, McGregor A, Jean-Marie J, Kooner JS. Acute hyperhomocysteinaemia and endothelial dysfunction. Lancet 1998;351:36-7.

Misra UK, Kalita J, Das A. Vitamin B12 deficiency neurological syndromes: A clinical, MRI and electrodiagnostic study. Electromyogr Clin Neurophysiol 2003;43:57-64.

Stabler SP, Lindenbaum J, Allen RH. Vitamin B12 deficiency in the elderly: Current dilemmas. Am J Clin Nutr 1997;66:741-9.

Ulleland M, Eilertsen I, Quadros EV, Rothenberg SP, Fedosov SN, Sundrehagen E, et al. Direct assay for cobalamin bound to transcobalamin (holo-transcobalamin) in serum. Clin Chem 2002;48:526-32.

Markle HV. Cobalamin. Crit Rev Clin Lab Sci 1996;33:247-356.

Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr 2004;24:299-326.

Fakhrzadeh H, Ghotbi S, Pourebrahim R, Nouri M, Heshmat R, Bandarian F, et al. Total plasma homocysteine, folate, and vitamin B12 status in healthy Iranian adults: The Tehran homocysteine survey (2003-2004)/a cross-sectional population based study. BMC Public Health 2006;6:29.

Herrmann W, Obeid R, Schorr H, Geisel J. The usefulness of holotranscobalamin in predicting vitamin B12 status in different clinical settings. Curr Drug Metab 2005;6:47-53.

Herrmann W, Geisel J. Vegetarian lifestyle and monitoring of vitamin B-12 status. Clin Chim Acta 2002;326:47-59.

Snow C. Laboratory diagnosis of vitamin B12 and folate deficiency. Arch Intern Med ???;???:???.

Stabler SP, Lindenbaum J, Allen RH. The use of homocysteine and other metabolites in the specific diagnosis of vitamin B-12 deficiency. J Nutr 1996;126 Suppl:1266S-72S.

Fenech MF, Dreosti IE, Rinaldi JR. Folate, vitamin B12, homocysteine status and chromosome damage rate in lymphocytes of older men. Carcinogenesis 1997;18:1329-36.

Campbell AK, Miller JW, Green R, Haan MN, Allen LH. Plasma vitamin B-12concentrations in an elderly latino population are predicted by serum gastrinconcentrations and crystalline vitamin B-12 intake. J Nutr 2003;133:2770-6.

Al Aisari F, Al-Hashmi H, Mula-Abed WA. Comparison between serum Holotranscobalamin and total vitamin B12 as indicators of vitamin B12 status. Oman Med J 2010;25:9-12.

Craig GM, Elliot C, Hughes KR. Masked vitamin B12 and folate deficiency in elderly. Br J Nutr 1985;54:613-19.

Stott DJ, Langhorne P, Hendry A, McKay PJ, Holyoake T, Macdonald J, et al. Prevalence and haemopoietic effects of low serum vitamin B12 levels in geriatric patients. Br J Nutr 1997;78:57-63.

Luong KV, Nguyen LT. Folate and vitamin B12-deficiency anemias in Vietnamese immigrants living in Southern California. South Med J 2000;93:53-7.

Mouallem M, Pauzner R, Maayan H, Farfel Z. Vitamin B12 deficiency; neurological disease with minimal or no anaemia. Harefuah 1990;118:385-86.

Lindenbaum J, Healton EB, Savage DG, Brust JC, Garrett TJ, Podell ER, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anaemia or macrocytosis. N Engl J Med 1988;318:1720-8.

Andrès E, Perrin AE, Demangeat C, Kurtz JE, Vinzio S, Grunenberger F, et al. The syndrome of food-cobalaminmalabsorption revisited in a department of internal medicine. A monocentric cohort study of 80 patients. Eur J Intern Med 2003;14:221-6.

Haltmayer M, Mueller T, Poelz W. Erythrocyte mean cellular volume and its relation to serum homocysteine, Vit B12 and folate. Acta Med Australia 2002;29:57-60.