ABSTRACT
A protein-bound Schilling test incorporating chick serum was used to study 16 elderly vitamin B12-deficient inpatients. Thirteen of these also underwent standard Schilling tests. They were compared with an age-matched control group of non-deficient inpatients. The lower limit of normal for assimilation of protein-bound vitamin B12 was 0.7%. Fourteen out of 16 deficient patients assimilated protein-bound vitamin B12 subnormally. Twelve of these were fully Schilling tested. Five assimilated free B12 normally, and five responded to intrinsic factor. One patient did not respond to intrinsic factor and had jejunal diverticulosis and one could not be categorized. One of two patients with normal assimilation had a borderline vitamin B12 intake. No subjects had neurological sequelae and only three were anaemic. In this population, B12 deficiency is usually asymptomatic but nearly always results from impaired assimilation possibly justifying replacement therapy. Schilling testing only affects treatment if there is other evidence of small-bowel dysfunction.
Subject(s)
Vitamin B 12 Deficiency/etiology , Age Factors , Aged , Aged, 80 and over , Carrier Proteins/blood , Female , Ferritins/blood , Folic Acid/blood , Humans , Intrinsic Factor/blood , Male , Middle Aged , Random Allocation , Schilling Test , Vitamin B 12 Deficiency/blood , Vitamin B 12 Deficiency/diagnosisABSTRACT
Vitamin B(12) assays and inspection of peripheral blood films performed on 1,004 consecutive new patients over the age of 50 admitted to mental hospital led to the discovery of pernicious anaemia in only two cases. It is concluded that routine vitamin B(12) assays are justified only when fully-automated techniques have become available.
Subject(s)
Mass Screening , Mental Disorders/blood , Vitamin B 12 Deficiency/diagnosis , Aged , Anemia, Pernicious/diagnosis , Humans , Intestinal Absorption , Middle Aged , Vitamin B 12/blood , Vitamin B 12/metabolismABSTRACT
Two hundred and thirty-eight ;megaloblastic' pregnancies are reviewed. Bone-marrow aspiration was performed in every case. Serum folate estimations were strongly suggestive of folic acid deficiency in only 34% of cases. If, however, the red cell folate was determined as well, there was an almost complete agreement with the changes in the erythroblasts. It is suggested that hyper-segmentation of the neutrophils in association with a diminished red cell folate level is indicative of significant folic acid deficiency. This series possibly shows a slight but statistically insignificant increase of accidental haemorrhage. No effect on birth weight or incidence of stillbirth was demonstrable.
