Hematological Findings in Cobalamin Deficiency with Special Reference to Hemolysis and Hyperhomocysteinemia
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 2
Abstract
Introduction. Co-existent hemolysis in patients with vitamin B12 deficiency is a well-recognized phenomenon. Hemolysis in megaloblastic anemia was traditionally thought to be due to intramedullary destruction of RBCs (ineffective erythropoiesis). However, the degree of hemolysis was higher in megaloblastic anemia and significantly correlated with hyperhomocysteinemia. In vitro study revealed that Homocysteine increased the risk of hemolysis in Vitamin B12 deficiency patients while its mechanisms are still not entirely understood and has not been demonstrated in clinical setting. Material and methods:30 patients of Megaloblastic anemia with hemolysis were taken as cases and and 30 cases of megaloblastic anemia without hemolysis were taken as control. Complete hemogram, schistocyte count (expressed in percentage) along with biochemical investigations (vitamin B12, folic acid, serum LDH, bilirubin, Homocysteine) were done. Result: Hemoglobin (Hb) values(gm/dl) in Megaloblastic anemia with hemolysis and without hemolysis were 5.62 ± 1.4 and 6.14 ± 2. Though mean total leucocyte count and total platelet count were within normal range in both these groups but some of the patients presented with leucopenia and thrombocytopenia. Reticulocyte count was increased i.e. 3.83 ± 1.5 in hemolysis group compared to control group where mean reticulocyte count was 1.06 ± 0.47. Schistocytes count is very much increased in hemolysis group. i.e 7.08 ± 3.19 and it was 1 ± 0.6 in control group. Homocysteine level was more increased in cobalamin deficiency with hemolysis i.e. 37.28 ± 15 as compared to control group where Homocysteine level was 31.15 ± 19. Indirect bilirubin was also increased in hemolytic cases. LDH level was slightly increase in cases where as it is normal in control groups. Conclusion:Cobalamine deficiency causes anemia,leucopenia,thrombocytopenia, pancytopenia as well as hemolytic blood picture. Our study confirms that there is well-known link between vitamin B12 and plasma homocysteine level. Both features of intramedullary destruction and extravascular hemolysis were evident and both hemolysis and pancytopenia as well as hyperhomocysteinemia were corrected by cobalamin treatments. So we hypothesize that high homocysteine level may be an important contributor leading to further hemolysis which is often seen in cobalamin deficiency.
Authors and Affiliations
Sandhya Biswal, Ranjana Giri, Urmila senapati
Keywords
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- EP ID EP467221
- DOI 10.9790/0853-1802073436.
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