A Common Problem in Infants: Vitamin B12 Deficiency

Abstract

Background. Nutritional vitamin B12 (VB12) deficiency is characterized by anemia, the inability to gain weight, delay or decline in development. Children of mothers with VB12 deficiency have a risk of nutritional VB12 deficiency. Prevention and early treatment are necessary to prevent irreversible neurological damage. We aimed to conduct a retrospective study to understand the characteristics of patients with VB12 deficiency.Methods. Our study included patients admitted to Baskent University Faculty of Medicine Pediatric Hematology outpatient clinic between January 2015 - February 2020 for VB12 deficiency. Their clinical and laboratory characteristics were retrospectively examined through the hospital automation system.Results. Vitamin B12 deficiency was detected in 129 of the 3198 patients; 100 of them were followed regularly. The mean age at admission of our patients was 10 +/- 12 months (1 month - 7.5 years); 98% of these children were aged 0-2 years. The mean VB12 level of our patients was 171.63 +/- 51.2 pg/ml (83 - 273), mean hemoglobin 11.2 +/- 1.37 g/dl (6.3 - 13.9), mean MCV 74.5 +/- 9.1 fl (54-106.5) and mean iron level was 54 +/- 23 mu g/dl (18 - 94). At the end of one month of loading therapy (oral or intramuscular, IM), the average VB12 level was 769 +/- 537 pg/ml (post loading). One month after the loading therapy (pre-maintenance) the average VB12 level was 426 +/- 156 pg/ml. In seven cases who received IM therapy, the loading treatment was performed for the second time. The mean VB12 level of the mothers of 85 cases was 174 +/- 127 pg/ml (134 - 650). VB12 deficiency was detected in 55% of mothers, VB12 level being between 200 - 300 pg/ml in 76%, and below 200 pg/ml in the 24%. The family members of 35% of our patients (including parents) had VB12 deficiency. Conclusions. In our country, routine screening of VB12 levels in infants is not performed; however, its early diagnosis and treatment can prevent many adverse effects mainly on the central nervous system. The fact that 98% of patients were 0-2 years old indicates that its deficiency may be quite high in the young age, and routine screening of this age group for VB12 deficiency and further studies for prophylaxis may be needed.