Niveles de vitamina B12: asociación con anemia, creatinina y transaminasas. Estudio de asociación cruzada

Lizet Paola Moreno Moreno; Luz Eugenia Pérez Jaramillo

doi:10.35454/rncm.v7n3.635

Autores

Lizet Paola Moreno Moreno Institución Prestadora de Servicios de Salud (IPS) Sura, Bogotá, Colombia.
Luz Eugenia Pérez Jaramillo Grupo de Investigaciones Clínicas Sura, Centro de Biociencias-Ayudas Diagnósticas. Medellín, Colombia.

DOI:

https://doi.org/10.35454/rncm.v7n3.635

Palavras-chave:

deficiência de vitamina B12, transcobalaminas, vitamina B12, anemia, creatinina, transaminases

Resumo

Introdução: os níveis de vitamina B12 podem variar devido a comorbidades co- mo doenças renais e hepáticas, o que po- de resultar em medições que não refletem adequadamente a deficiência ou elevação desta vitamina. Isso afeta a precisão das faixas de referência e a verdadeira preva- lência de suas alterações. Objetivo: determinar a prevalência de alterações nos níveis de vitamina B12 e sua associação com anemia, níveis de creatinina e transaminases em uma popu- lação colombiana. Métodos: estudo transversal. Foram analisados pacientes com medições de vitamina B12 em Bogotá, Medellín, Cali e Barranquilla, vinculados a uma entidade de serviços de saúde na Colômbia durante o ano de 2017. Avaliou-se a relação entre os níveis de vitamina B12 e a presença de anemia, bem como os níveis de creatinina e transaminases. Resultados: foram incluídos 24.897 pacientes. A prevalência de deficiência de vitamina B12 foi de 2,60 % e 3,30 % de acordo com as faixas de referência do laboratório e da literatura, respectivamen- te. 11,86 % dos pacientes apresentavam níveis elevados de vitamina B12. A anemia macrocítica não foi comum na deficiência de vitamina B12. Observou-se uma maior proporção de pacientes com níveis eleva- dos de creatinina e transaminases entre aqueles com níveis altos de vitamina B12. Conclusões: a prevalência de deficiência de vitamina B12 foi baixa em comparação com outras populações. Não foi encontrada associação com a presença de macrocitose. Níveis elevados de vitamina B12 foram ob- servados em pacientes com alterações na creatinina e nas transaminases, indicando uma possível elevação espúria.

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Referências

Jajoo SS, Zamwar UM, Nagrale P. Etiology, Clinical Manifestations, Diagnosis, and Treatment of Cobalamin (Vitamin B12) Deficiency. Cureus. 2024;16(1):e52153. doi: 10.7759/cureus.52153

Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003;67(5):979-86.

Martinho KO, Tinôco ALA, Ribeiro AQ. Prevalence and fac- tors associated with vitamin B12 deficiency in elderly from VIÇOSA/MG, Brasil. Nutr Hosp. 2015;32(5):2162-68. doi: 10.3305/nh.2015.32.5.9648

Wong E, Molina-Cruz R, Rose C, Bailey L, Kauwell GPA, Rosenthal J. Prevalence and Disparities in Folate and Vitamin B12 Deficiency Among Preschool Children in Guatemala. Matern Child Health J. 2022;26(1):156-67. doi: 10.1007/ s10995-021-03257-6

Andrés E, Serraj K, Zhu J, Vermorken AJ. The pathophy- siology of elevated vitamin B12 in clinical practice. QJM. 2013;106(6):505-15. doi: 10.1093/qjmed/hct051

Chiche L, Jean R, Romain F, Roux F, Thomas G, Canavese S, et al. Clinical implications of high cobalamin blood levels for internal medicine. Rev Med Interne. 2008;29(3):187-94. doi: 10.1016/j.revmed.2007.07.007

Brah S, Chiche L, Mancini J, Meunier B, Arlet JB. Characteristics of patients admitted to internal medicine departments with high serum cobalamin levels: results from a prospective cohort study. Eur J Intern Med. 2014;25(5):57. doi: 10.1016/j.ejim.2014.01.014

Carmel R, Vasireddy H, Aurangzeb I, George K. High serum cobalamin levels in the clinical setting--clinical associations and holo-transcobalamin changes. Clin Lab Haematol. 2001;23(6):365-71. doi: 10.1046/j.1365-2257.2001.00134.x

Valdivia G, Navarrete C, Oñate A, Schmidt B, Fuentes R, Espejo E, et al. Association between high vitamin B12 levels and one year mortality in older people admitted to the hospi- tal. Rev Med Chil. 2020;148(1):46-53. doi: 10.4067/S0034- 98872020000100046

Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood. 2017;129(19):2603-11. doi: 10.1182/blood-2016-10-569186

Abbott Ireland. Architect System B12 [Internet]. Abbott; 2010 [Consultado el 8 de febrero de 2023]. Disponible en: https://www.corelaboratory.abbott/int/es/offerings/ brands/architect.html

Méndez-Chacón RC. Guía de procedimiento: Dosaje de vitaminas séricas. Unidad de soporte al diagnóstico y trata- miento. Subunidad de soporte al diagnóstico-Patología clínica [Internet]. Perú: Ministerio de Salud; 2021 [Consultado el 8 de febrero de 2023]. Disponible en: https://portal.insnsb. gob.pe/docs-trans/resoluciones/archivopdf.php?pdf=2021/ RD%20N%C2%B0%20000250-2021-DG-INSNSB%20 GP%20065%20-%20GUIA%20DOSAJE%20DE%20 VITAMINAS%20SERICAS_.pdf

Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-60. doi: 10.1056/NEJMcp1113996

Teradata® SQL Assistant. Tools and Utilities Release Definition- 20.00. [Internet]. Teradata; 2023 [consultado el 10 de mayo de 2023]. Disponible en: https://docs.teradata.com/r/Teradata- Tools-and-Utilities-Release-Definition/October-2018/ Product-Information/Teradata-SQL-Assistant

Cuevas-Nasu L, Mundo-Rosas V, Shamah-Levy T, Méndez- Gómez Humaran I, Avila-Arcos MA, Rebollar-Campos MdR, et al. Prevalence of folate and vitamin B12 deficiency in Mexican children aged 1 to 6 years in a population-based survey. Rev. Invest. Salud Publica. 2012;54(2):116-24. doi: 10.1590/s0036-36342012000200007

Sukumar N, Rafnsson SB, Kandala N, Bhopal R, Yajnik CS, Saravanan P. Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis. Am J Clin Nutr. 2016;103(5):1232- 51. doi: 10.3945/ajcn.115.123083

Anaya-Loyola MA, Brito A, Villalpando S, Allen LH. Prevalence of low serum vitamin B12 in Mexican children and women: results from the first National Nutrition Survey (1999) as a basis for interventions and progress. Int J Vitam Nutr Res. 2020;90(3-4):325-32. doi: 10.1024/0300-9831/a000579

Shamah-Levy T, Villalpando S, Mejía-Rodríguez F, Cuevas- Nasu L, Gaona-Pineda EB, Rangel-Baltazar E, et al. Prevalence of iron, folate, and vitamin B12 deficiencies in 20 to 49 years old women: Ensanut 2012. Rev Invest Salud Publica. 2015;57(5):385-93. doi: 10.21149/spm.v57i5.7618

Quay TAW, Schroder TH, Jeruszka-Bielak M, Li W, Devlin AM, Barr SI, et al. High prevalence of suboptimal vitamin B12 status in young adult women of South Asian and European ethnicity. Appl Physiol Nutr Metab. 2015;40(12):1279-86. doi: 10.1139/apnm-2015-0200

Flood VM, Smith WT, Webb KL, Rochtchina E, Anderson VE, Mitchell P. Prevalence of low serum folate and vitamin B12 in an older Australian population. Aust N Z J Public Health. 2006;30(1):38-41. doi: 10.1111/j.1467-842x.2006.tb00084.x

Yao Y, Yao SL, Yao SS, Yao G, Lou W. Prevalence of vitamin B12 deficiency among geriatric outpatients. J Fam Pract. 1992;35(5):524-8.

Martínez-Marín JD, Henao-Riveros SC, Rey-Tovar MH. Niveles de vitamina B12 en pacientes colombianos con gastritis crónica atrófica. Rev Colomb Gastroenterol. 2010;25(3):261-4.

Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood. 2017;129(19):2603-11. doi: 10.1182/blood-2016-10-569186

Yang DT, Cook RJ. Spurious elevations of vitamin B12 with pernicious anemia. N Engl J Med. 2012;366(18):1742-3. doi: 10.1056/NEJMc1201655

Carmel R, Agrawal YP. Failures of cobalamin assays in per- nicious anemia. N Engl J Med. 2012;367(4):385-6. doi: 10.1056/NEJMc1204070

Merrigan SD, Yang DT, Straseski JA. Intrinsic factor blocking antibody interference is not detected in five automated coba- lamin immunoassays. Am J Clin Pathol. 2014;141(5):702-5. doi: 10.1309/AJCPPWHSB94FTOGU

Oberley MJ, Yang DT. Laboratory testing for cobala- min deficiency in megaloblastic anemia. Am J Hematol. 2013;88(6):522-6. doi: 10.1002/ajh.23421

Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine deter- minations for diagnosing cobalamin and folate deficien- cies. Am J Med. 1994;96(3):239-46. doi: 10.1016/0002- 9343(94)90149-x

Tseng F, Huang T. Using data mining technology to explore homocysteine at low levels. Medicine (Baltimore). 2021;100(33):e26893. doi: 10.1097/ MD.0000000000026893

Harrington DJ. Laboratory assessment of vitamin B12 sta- tus. J Clin Pathol. 2017;70(2):168-73. doi: 10.1136/jclin- path-2015-203502

Hvas AM, Nexo E. Holotranscobalamin--a first choice assay for diagnosing early vitamin B deficiency? J Intern Med. 2005;257(3):289-98. doi: 10.1111/j.1365-2796.2004.01437.x

Morkbak AL, Hvas A, Milman N, Nexo E. Holotranscobalamin remains unchanged during pregnancy. Longitudinal changes of cobalamins and their binding proteins during pregnancy and postpartum. Haematologica. 2007;92(12):1711-2. doi: 10.3324/haematol.11636