Vitamin B12 And Folate Deficiency In a Hospital Population

Abstract

This is a study of B12 and folate deficiency in a hospital population. We studied the incidence of their deficiency by evaluating blood levels in every tenth hospital admission. Among the 450 patients chosen, 417 had normal levels of both, 2 had deficiency of folate alone (folate < 3ng.ml), 3 had B12 deficiency alone (B12<200pg/ml)and 11 had deficiency of both (total 3.5%). In addition 12 had borderline b12 level(200-300pg/ml), 2 had borderline folate level (3-4ng/ml)(0.44%)and 3 had borderline levels for both (0.66%) . Thus 33% had definite or borderline deficiency. This deficiency was more common in the elderly and in patients on vegetarian diet (5.7% definite deficiency, 8.8% borderline levels) compared to those on a non-vegetarian diet. During the 2 1/2 years of the study a total of 99 definite deficiency and 69 borderline deficiency were seen. In the definite deficiency group, 22.3% had neuropathy, 6.1% had evidence of myelopathy, 18.2% had neuropsychiatric changes (memory defect, dementia, behavioural abnormalities, depression) and 4.1% had cerebellar signs. The neurologic findings in the borderline group were almost similar (neuropathy 29%, myelopathy 8.6% and neuropsychiatric changes 18.4%). High mean corpuscular volume (MCV> 95) was seen in 69% of those with both B12 and folate deficiency, 43.4% with B12 deficiency and 61.15 with folate deficiency. Hypersegmented polymorphs were seen in 21.7% with B12 deficiency, 27.5% with folate both B12 and folate deficiency had either megaloblastosis or dimorphic picture. It is to be noted that B12 and folate deficiency in this population was more frequent than we previously considered and reliance on haematologic parameters will miss half to one third of all cases. As expected B12 deficiency is more frequent in vegetarians than non-vegetarians.