[ Study of neutrophil hyper segmentation in elderly and its diagnostic value for cobalamin and folic acid deficiency in Mashhad, Iran]

ABSTRACT

The prevalence of cobalamin and folic acid is high in elderly. Ambiguous clinical findings, various laboratory methods and normal range and cost of laboratory tests have been resulted in complexity and delay of the deficiency diagnosis. The aim of this study is to evaluate the relation between hematologic parameters, especially neutrophil hypersegmentation and cobalamin and folic acid insufficiency as well as increased serum hemocystein. Three hundred subjects more than 65 years age from twelve regions of Mashhad were studied. This population was selected by the Provincial Health Center. 250 subjects were analyzed for serum cobalamin and folate by RIA method. 78 subjects, who had cobalamin 120-450 pg/ml and folate 1.5-17ng/ml without any confounders, were analyzed for homocystein [Hcy] by Elisa method. Hematological parameters were assayed by H1 system and blood smear by microscopic observation. Data were analyzed by SPSS 11.5 software. p<0.05 was considered statistically significant. Among 235 participants, 45.5% and 54.5% were positive and negative for neutrophil hypersegmentation [NH], respectively. Significant correlation was not found between NH and gender. In 216 subjects, 56.7% had red blood cell macrocytosis. There was a significant relation between severity of NH and macrocytosis [p=0.001]. Macrocytosis had significant correlation with folate deficiency [p=0.017]. NH showed a statistically significant relation with folate [p=0.036], however, no correlation with cobalamin<122 pg/ml and increased homocystein. Folate showed significant relation with increased homocystein [p= 0.001]. Specificity and sensitivity of NH for diagnosis of cobalamin and folate deficiency was low. With respect to the high incidence of folate deficiency in elderly, a simple and economic screening test such as NH and macrocytosis could be performed for evaluation of serum folate. Although the specificity and sensitivity of NH for diagnosis of folate deficiency is not high, it may be used as a screening test