Vitamin B12 Deficiency In Patients With Normal Blood Count

Vitamin B12 (Cobalamine) is essential for protein synthesis, cell proliferation and optimal systemic function, particularly for nervous system and blood. Moderate vitamin B12 deficiency is common even with normal hematological parameters. Diagnosis and treatment are delayed because of non-specific symptoms, normal blood count and lack of awareness.

To find out the prevalence of hidden vitamin B12 deficiency in patients with normal blood count.

We reviewed the results of vitamin B12 tests which were ordered for patients at King Khalid University Hospital, King Saud University between 1^st of January- 30^thof December 2012. Those with low vitamin B12 and normal blood count were contacted and interviewed and were asked for consent to participate in this retrospective study and to answer detailed medical history questions on dietary habits, medical illnesses, gastro-intestinal surgical procedures, and long term medications.

 Out of 3045 patients, there were 415 (155 males and 260 females, aged  36 +/- 18 years) with normal blood count, but low vitamin B12 level, which was between 40-140 pmol/l ( normal 145-637). 350 patients agreed (81 males and 170 females), but complete information was obtained only from 251 patients (71.71%). Symptoms included fatigue, tingling and numbness, impaired short-term memory, insomnia and impaired concentration. Identified causes of Vitamin B12 deficiency were as follows: 65 patients (26%) had partial gastrectomy, 12 (5%) had resection of the terminal ileum, 16 (6%) had gastric atrophy, 18 (7%) had celiac disease, 36 (14%) were vegetarians, 49 (20%) were diabetic on metformin, 47 (19%) were on proton pump inhibitors, and in 8 (3%) the cause could not be identified.

Vitamin B12 deficiency is common   even in patients with normal hematological values. There is a need for continuous  awareness program for physicians, dietitians, and general population to identify risk factors, and to implement guidelines for prevention, early detection and treatment of hidden Vitamin B12 deficiency.

No relevant conflicts of interest to declare.