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Combined cobalamin and iron deficiency anemia: a diagnostic approach using a model based on age and homocysteine assessment.
Ann Hematol. 2013 Apr; 92(4):527-31.AH

Abstract

Macrocytosis, the hallmark of cobalamin/folate deficiency anemia, is frequently absent. Clinicians have to be aware of coexisting conditions that can mask the macrocytosis expression of megaloblastic anemia, especially iron deficiency. The objective of this work was to investigate the degree of overlap between iron deficiency anemia (IDA) and cobalamin deficiency and to develop a predictive model for differentiating IDA from combined deficiency. A prospective case and control study was carried out to investigate vitamin B12 and folate status in iron deficiency anemia. A total of 658 patients were recruited, 41 of whom (6.2 %) were excluded. The remaining 617 subjects consisted of 130 controls and 487 with IDA. Low vitamin B12 (LB12) was considered when serum vitamin B12 was ≤200 pmol/L. High serum homocysteine (Hcy) was defined by Hcy >17 μM/L. A multivariate analysis (including a logistic regression) was performed to develop a diagnostic model. Low vitamin B12 levels were found in 17.8 % of IDA subjects. Ten out of 11 subjects (91 %) with IDA and serum vitamin B12 (B12) ≤100 pmol/L showed vitamin B12 deficiency. Moreover, vitamin B12 deficiency was demonstrated in 48 % of cases with IDA and B12 between 101 and 150 pmol/L and in 40 % with IDA and B12 between 151 and 200 pmol/, respectively. As a result of multivariate logistic analysis, neutrophil counts and age predicted subjects with vitamin B12 ≤200 and Hcy >17 μmol/L, [Formula: see text]. Using the age of 60 as a cutoff, sensitivity was 91 % (39 out of the 43 patients with vitamin B12 deficiency and IDA were identified). In summary, low vitamin B12 was found in 18 % of patients with IDA. Vitamin B12 deficiency was demonstrated in many patients with LB12 and IDA. Age over 60 years was used to separate patients with combined deficiency (sensitivity 91 %). Therefore, for a diagnostic purpose, serum vitamin B12 should be evaluated in IDA patients over 60 years. This diagnostic model needs to be validated in a different population.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Remacha AF
Hematology Department, Hospital de Sant Pau, Avda Padre Claret 167, Barcelona, 08025, Spain. aremacha@santpau.cat
Sardà MP
No affiliation info available
Canals C
No affiliation info available
Queraltò JM
No affiliation info available
Zapico E
No affiliation info available
Remacha J
No affiliation info available
Carrascosa C
No affiliation info available

MeSH

AdultAge FactorsAgedAged, 80 and overAnemia, Iron-DeficiencyCase-Control StudiesDecision Support TechniquesDiagnostic Techniques and ProceduresFemaleHematologyHomocysteineHumansMaleMiddle AgedRegression AnalysisSensitivity and SpecificityVitamin B 12Vitamin B 12 Deficiency

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

23183879

Citation

Remacha, Angel F., et al. "Combined Cobalamin and Iron Deficiency Anemia: a Diagnostic Approach Using a Model Based On Age and Homocysteine Assessment." Annals of Hematology, vol. 92, no. 4, 2013, pp. 527-31.
Remacha AF, Sardà MP, Canals C, et al. Combined cobalamin and iron deficiency anemia: a diagnostic approach using a model based on age and homocysteine assessment. Ann Hematol. 2013;92(4):527-31.
Remacha, A. F., Sardà, M. P., Canals, C., Queraltò, J. M., Zapico, E., Remacha, J., & Carrascosa, C. (2013). Combined cobalamin and iron deficiency anemia: a diagnostic approach using a model based on age and homocysteine assessment. Annals of Hematology, 92(4), 527-31. https://doi.org/10.1007/s00277-012-1634-8
Remacha AF, et al. Combined Cobalamin and Iron Deficiency Anemia: a Diagnostic Approach Using a Model Based On Age and Homocysteine Assessment. Ann Hematol. 2013;92(4):527-31. PubMed PMID: 23183879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined cobalamin and iron deficiency anemia: a diagnostic approach using a model based on age and homocysteine assessment. AU - Remacha,Angel F, AU - Sardà,M P, AU - Canals,C, AU - Queraltò,J M, AU - Zapico,E, AU - Remacha,J, AU - Carrascosa,C, Y1 - 2012/11/25/ PY - 2012/10/23/received PY - 2012/11/13/accepted PY - 2012/11/28/entrez PY - 2012/11/28/pubmed PY - 2013/4/30/medline SP - 527 EP - 31 JF - Annals of hematology JO - Ann Hematol VL - 92 IS - 4 N2 - Macrocytosis, the hallmark of cobalamin/folate deficiency anemia, is frequently absent. Clinicians have to be aware of coexisting conditions that can mask the macrocytosis expression of megaloblastic anemia, especially iron deficiency. The objective of this work was to investigate the degree of overlap between iron deficiency anemia (IDA) and cobalamin deficiency and to develop a predictive model for differentiating IDA from combined deficiency. A prospective case and control study was carried out to investigate vitamin B12 and folate status in iron deficiency anemia. A total of 658 patients were recruited, 41 of whom (6.2 %) were excluded. The remaining 617 subjects consisted of 130 controls and 487 with IDA. Low vitamin B12 (LB12) was considered when serum vitamin B12 was ≤200 pmol/L. High serum homocysteine (Hcy) was defined by Hcy >17 μM/L. A multivariate analysis (including a logistic regression) was performed to develop a diagnostic model. Low vitamin B12 levels were found in 17.8 % of IDA subjects. Ten out of 11 subjects (91 %) with IDA and serum vitamin B12 (B12) ≤100 pmol/L showed vitamin B12 deficiency. Moreover, vitamin B12 deficiency was demonstrated in 48 % of cases with IDA and B12 between 101 and 150 pmol/L and in 40 % with IDA and B12 between 151 and 200 pmol/, respectively. As a result of multivariate logistic analysis, neutrophil counts and age predicted subjects with vitamin B12 ≤200 and Hcy >17 μmol/L, [Formula: see text]. Using the age of 60 as a cutoff, sensitivity was 91 % (39 out of the 43 patients with vitamin B12 deficiency and IDA were identified). In summary, low vitamin B12 was found in 18 % of patients with IDA. Vitamin B12 deficiency was demonstrated in many patients with LB12 and IDA. Age over 60 years was used to separate patients with combined deficiency (sensitivity 91 %). Therefore, for a diagnostic purpose, serum vitamin B12 should be evaluated in IDA patients over 60 years. This diagnostic model needs to be validated in a different population. SN - 1432-0584 UR - https://www.unboundmedicine.com/medline/citation/23183879/Combined_cobalamin_and_iron_deficiency_anemia:_a_diagnostic_approach_using_a_model_based_on_age_and_homocysteine_assessment_ L2 - https://dx.doi.org/10.1007/s00277-012-1634-8 DB - PRIME DP - Unbound Medicine ER -