1. Objectives Results Methods Conclusion Results
paraesthesias
numbness
weakness
loss of dexterity
impaired memory
personality changes
glossitis
vaginal atrophy
malabsorption
axonal and demyelinating neuropathy
bone loss
paraesthesias
numbness
weakness
loss of dexterity
impaired memory
personality changes
glossitis
vaginal atrophy
malabsorption
axonal and demyelinating neuropathy
bone loss
All older patients should receive opportunistic screening for vitamin B12 deficiency
Abdelnour L1, Ahern E2 , Pillay 11,
1South Tipperary General Hospital, Clonmel, Co. Tipperary, Ireland
2St Luke’s Hospital, Kilkenny, Ireland
Objectives
Results
A retrospective analysis of vitamin B12 assays was performed to explore the relationship between patient age, haemoglobin, mean corpuscular volume (MCV) and vitamin B12 level.
Neither haemoglobin nor MCV was predictive of deficiency even in the most deficient B12 samples.
B12 deficient
Group
N = 54
Normal B12 levels
N = 61
Mean MCV
93.31
89.74 SD
10.35
6.20
Methods
From January 2010 through to the end of April 2010, 2768 consecutive vitamin B12 results were matched with age, haemoglobin and MCV. These were performed in a 253-bedded hospital, where it is policy to screen all medical inpatients admitted over the age of 65 years for vitamin B12 deficiency.
Figure 1:
MCV in samples taken from patients over 65 years with B12 deficiency and without.
Conclusion
Results
B12 deficiency may result in a variety of subtle symptoms and signs (Table 1). The window of opportunity for effective intervention may be as short as one year from the onset of symptoms. Haematological changes typical of megaloblastic anaemia are usually absent. Screening for B12 deficiency in the absence of haematological abnormalities should be part of any medical unit dealing with older patients.
3.5%, n=107 samples showed B12 deficiency as defined as lower than 160pg/ml. 48%, n=51 of deficient patients were over the age of 65 years, with a mean, SD age of 78, 6.7 years. The mean haemoglobin in this group was 11.7, 1.7 g/dl with a mean, SD MCV of 93.6, 10.5.
A macrocytic anaemia was present in just 0.1% (N=5) of the vitamin B12 deficient samples. Anaemia, defined as haemoglobin less than 11.8g/dl, was present in 67% (N=34) vitamin B12 deficient samples with 33% (N=17) patients displaying a normal haemoglobin, 3 of whom had B12 levels less than 83pg/ml. An age-matched sample with normal vitamin B12 results, mean 182, SD 10.6 had a mean, SD age of 78.7, 7.8 years. The mean, SD haemoglobin was higher at 12.2g/dl, SD 1.7. The mean, SD MCV was lower at 89.8, 6.0. 
Table 1:
The symptoms and signs of B12 deficiency.
Paraesthesias
Numbness
Weakness
Loss of dexterity
Impaired memory
Personality changes
Glossitis
Vaginal atrophy
Malabsorption
Axonal and demyelinating neuropathy
Bone loss
Opportunistic screening is the only pragmatic way to effectively diagnose and treat these patients.