Lenin Thomas* and Sasidharan PK*
Department of General Medicine, PVS Hospital, Kozhikode, Kerala, IndiaFulltext PDF
Background: Vitamin B12 deficiency is very common in the general population of India. Subclinical B12 deficiency could be easily missed in clinical practice, as the symptoms are vague and numerous and are often overlooked or ignored due to lack of awareness. Early B12 deficiency can be identified by studying the dietary habits of the patients, because the root cause of nutritional deficiencies lies in their poor dietary habits, about which they are not aware of. It will be a good clinical practice to identify the deficiency early and advice on balanced diet which in the long run would bring about a social change. Objectives: To identify the common presentations of B12 deficiency, to make a strong clinical suspicion of B12 deficiency based on the pitfalls in dietary habits, to initiate early treatment, to assess the response to treatment in patients with established B12 deficiency and to prevent recurrence. Methods: This was a prospective study of 203 patients with clinical and hematological evidence of B12 deficiency who attended the outpatient department of PVS Hospital Calicut. The patients were evaluated for their symptoms, dietary practices, physical signs and laboratory tests including Vitamin B12 levels. Results: Fatigue was the most common symptom, seen in 65% of patient’s and was apparently due to anemia suggesting that most common clinical presentation can still be hematological. Anorexia was the next common and was seen in 57% of patients, which could have been multifactorial including gastric mucosal atrophy. Skin hyperpigmentation was seen in 40% of patients. Pallor was present in 70% of patients and Romberg’s sign was present in 71% of patients. Evidence suggestive of peripheral neuropathy was seen in 25% and psychiatric manifestations including irritability, depression, memory disturbances were seen in 23% of patients. Neuropsychiatric manifestations were seen independent of any hematological manifestations in B12 deficiency. B12 assay showed low levels in 65% of patients only. Majority (67%) of the study group with B12 deficiency had poor intake of fruits and vegetables too and 52% of them had deficient meat or other protein intake. Conclusion: B12 deficiency can present with any of the numerous manifestations affecting hematopoiesis, skin & mucosa and the entire nervous system, including mental functions. Overt B12 deficiency with classical signs and symptoms can be picked up easily, but subclinical cases are easily missed. All patients will not present with classical hematological or neurological manifestations. The key is to suspect the deficiency by remembering the most common symptoms and their correlation with the dietary habits. Since the awareness and practice of a balanced diet is very poor in our society, B12 deficiency can be seen very commonly in clinical practice but is easily overlooked unless we look for it. We miss them because the ‘eyes will not see what the mind doesn’t know’.
Vitamin Bl2; Balanced Diet; Hyperpigmentation; Health education
Thomas L, Sasidharan PK. Clinical Profile of Vitamin B12 Deficiency and Response to Treatment. Ann Clin Med Res. 2021; 2(7): 1052..