Hidoc Bulletin

For normal functioning, a healthy body requires a continuous supply of nutrients. The body’s homeostasis is based on the fine delicate balance between these essential nutrients. Some are needed in large quantities (macronutrients) and some in small amounts (micronutrients). A minute deficiency of any of the life-saving nutrients causes big health complications. One such threatful common clinical condition of this era is Vitamin B12 deficiency. It is more challenging because it does not show obvious clinical presentation mostly which makes diagnosis and treatment even more difficult. As reported in Indian J Endocrinol Metab 2019, India’s prevalence of vitamin B12 deficiency ranges from 16% to 77%.

Why vitamin B12 is so crucial?

Vitamin B12 (cobalamin) acts as an important cofactor in methylation reactions for  DNA & cell metabolism. Reduction in vitamin B12 levels disrupts usual cell functioning, leading to deadly variable clinical consequences.

What are the complications of vitamin B12 deficiency? 

Cellular and molecular consequences:- Damaged metabolism of  methylmalonate derived from the breakdown of amino acids and fatty acids. Accumulation of homocysteine and less production of methionine and S-adenosylmethionine. 

Generation of stress 

Neurological manifestations: Demyelination of peripheral and central neurons, leading to weakened nervous system functioning 

Haematological manifestations: Development of megaloblastic anaemia, imbalanced bone marrow division and production of abnormally large cells. 

What are the symptoms?

In infants: Difficulty feeding, irritability, regurgitations, constipation, pancytopenia and apathy. Development of twitching, tremors and myoclonic jerks. Demonstrate slow growth, small head circumference & brain lesions. Developmental delays, reduction in gross motor development, smiling & babbling.

In older children: Hampered school performance, The disparity in weight, height and head circumference, Occurrence of macrocytic anaemia, Diminished mental performance, attention, short-term memory concentration and social development. 

In adults: Presence of megaloblastic or macrocytic anaemia, Degeneration of spinal cord and one disease, Reduced nerve functioning (sensory and peripheral) and hearing loss, Poor cognitive functioning and depression, Macular degeneration. 

What are the causes of vitamin B12 deficiency?

Pernicious anaemia due to insufficient B12 absorption, Gastric disease or surgery, Chronic atrophic gastritis, Pancreatic disease or pancreatectomy, Intestinal diseases like ileal resection, parasitic infestations & bacterial overgrowth causing compromised B12–intrinsic factor complex absorption, Medications (cholestyramine and metformin) affecting B12 absorption or metabolism, Dietary factors like malnutrition, vegetarian or vegan diet, & chronic alcoholism, Inherited disorders, Miscellaneous factors like HIV infection and nitrous oxide anaesthesia.

What kind of treatment and management can be proposed?

Identification of the cause, Administration of expert-recommended hydroxocobalamin and folic acid doses, Providing supportive care and recommending the right dietary advice, Maintenance of healthy vitamin B12 level through regular follow up, Creating vitamin B12 deficiency awareness among the population. 

Conclusion:

The danger of vitamin B12 deficiency can be averted and minimized by proactively recognising silent symptoms, diagnosing vitamin B12 deficiency with appropriate screening methodologies, incorporating timely suitable interventions and offering sufficient comprehensive therapy care. For normal functioning, a healthy body requires a continuous supply of nutrients. The body’s homeostasis is based on the fine delicate balance between these essential nutrients. Some are needed in large quantities (macronutrients) and some in small amounts (micronutrients). A minute deficiency of any of the life-saving nutrients causes big health complications. One such threatful common clinical condition of this era is Vitamin B12 deficiency. It is more challenging because it does not show obvious clinical presentation mostly which makes diagnosis and treatment even more difficult. As reported in Indian J Endocrinol Metab 2019, India’s prevalence of vitamin B12 deficiency ranges from 16% to 77%.