Vitamin B12 Deficiency after a Total Gastrectomy in Patients with Gastric Cancer

PURPOSE: The most common metabolic defect appearing following a gastrectomy is anemia. Two types have been identified: One is related to a deficiency in iron and the other is related to an impairment in vitamin B12 metabolism. The purpose of this study is to evaluate the incidence and treatment of vitamin B12 deficiency after a total gastrectomy. MATERIALS AND METHODS: Serum vitamin B12 concentrations were measured in 128 patients who had undergone a total gastrectomy. The group with a serum concentration under 200 pg/ml was supplemented at one-month intervals with Actinamide and five-six months later, serum concentrations of the vitamin B12 were rechecked. RESULTS: The group with vitamin B12 under 200 pg/ml was 61 (47.6%) of the 128 patients who had undergone a total gastrectomy. In this group, the cumulative incidences of vitamin B12 deficiency were 7.0, 23.4, 33.6, 39.1, 41.4, and 47.7% at 6 months, 1, 2, 3, 4, and 5 or more years, respectively. The treated group with vitamin B12 under 200 pg/ml had 36 (28.17%) of the 128 patients. The 16 of those cases with vitamin B12 levels of 100~150 pg/ml were supplemented 5.21 times and the vitamine B12 was elevated to above 650 pg/ml. The other 20 cases with an average of vitamin B12 levels of 150~200 pg/ml were supplemented an average of 4.75 times, and the vitamin B12 was elevated to above 780 pg/ml. CONCLUSION: It is necessary to supplement vitamin B12 even 1 year later after a total gastrectomy. The group with vitamin B12 under 200 pg/ml was supplemented 5~6 times at one-month intervals with Actinamide 1,000microgram IM injections and reached normal levels.

A Study for Incidence and Treatment of Vitamin B12 Deficiency after Total Gastrectomy

PURPOSE: Vitamin B12 (VB12) deficiency is an inevitable sequela of a total gastrectom, which results in general symptoms, including easy fatigue, and hematological, neurological, and gastrointestinal complications. Especially in cases of neurological injury, it may be irreVersible if the timely treatment is delayed. Therefore the early diagnosis and treatment is essential. However, no guidelines exist for the incidence or treatments. METHODS: We investigated the symptoms and serum VB12 concentrations of 296 patients who underwent a total gastrectomy for a gastric malignancy. We defined 200~300 pg/ml as the mild decrease group, under 200 pg/ml as the severe decrease group, and over 300 pg/ml as the normal limit. RESULTS: The cumulative incidence of VB12 deficiency were 5.1, 11.2, 29.9, 44.7, 64.5% at 6 month, 1, 2 and 3 years, and at 4 or more years, respectively. The 90% of patients reported at least 1 symptom. The group under 200 pg/ml was supplemented at 1 month intervals; 10 of the 16 patients (63%) had their VB12 elevated to above 300 pg/ml. The group between 200~300 pg/ml was supplemented at 1 or 3 month intervals; 21 out of 23 (91%), and 12 out of 15 patients (80%) had their B12 elevated to above 300 pg/ml at the 1 and 3 month intervals, respectively, but with no statistical significance. CONCLUSION: The group with a V12 under 200 pg/ml should be supplemented 6 times, at 1 month intervals, regardless of the symptom presentation, and when the rechecked serum VB12 level has been increased above 300 pg/ml, it should be supplemented at 3 month intervals. In the group with a VB12 between 200 and 300 pg/ml, the VB12 should be supplemented at 3 month intervals if the symptom is present, and the asymptomatic group should be observed.

Efficacy of Ferritin - folate - cyanocobalamin Supplementation during Pregnancy for Prevention of Anemia / 대한주산의학회잡지

OBJECTIVE: The purpose of this study is to evaluate the efficacy of ferritin-folate-cyanocobalamin supplementation for prevention of anemia during pregnancy. METHODS: The authors conducted a clinical investigation on 50 pregnant women from 20th to 36th gestational weeks. The cobination of cyanocobalamin coenzyme 500mg, folic coenzyme 800mcg, and ferritin 20mg constituted the supplementation. The parameters examined in first trimester as baseline, before treatment(at 20th weeks), and after treatment(at 36th weeks) were : hemoglobin, hematocrit, ferritin, mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), mean corpuscular volume(MCV), red blood cell count(RDW), folic acid, and vit. BPaired sample t-test was used for comparison. RESULTS: The results indicated a significant increase in the value of hemoglobin(p<0.05) and hematocrit(p<0.01) in comparison to before and after the treatment. The values of serum ferritin, folic acid, vitamin Bwere increased after the treatment compared to those of before the treatment, though there was no statistical significance. The results of MCV, MCH, MCHC, and RDW showed no statistically significant in comparison to before and after the treatment. CONCLUSIONS: These data indicate that supplementing ferritin 20mg-folate 800mcg-cyanocobalamine 500mcg per day from 20th to 36th weeks' gestation can increase values of hemoglobin, hematocrit, and ferritin concentration and can be cosidered as an appropriate method to prevent iron deficient anemia. It also might increase the value of folic acid and vitamin B12, concentration, but further study is stiU needed to determine whether the supplementation of folate and cyanocobalamine in combination with iron can have better eflicacy than iron alone in prevention of iron deficiency anemia.