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ABSTRACT
Background
Vitamin B12 and folate are essential micronutrients for DNA synthesis in haemopoietic cells, epithelium, and neural cells, and their deficiency may lead to various clinical manifestations, ranging from megaloblastic anaemia to neurological disorders if not treated promptly. The prevalence of vitamin B12 and folate deficiencies is unknown at Dr George Mukhari Academic Laboratory (DGMAL). Aim: To determine the prevalence of vitamin B12 and folate deficiencies, the associated haematological features, and routine biochemical tests performed in vitamin B12 deficiency to confirm pernicious anaemia at DGMAL.
Method
A cross-sectional review of serum vitamin B12 and folate deficiencies was performed at DGMAL from 1 March 2021 to 31 February 2022. Following ethical approval, these results were extracted from the National Health Laboratory Service laboratory information system.
Result
One hundred and eighty patient cases satisfied the criteria. Vitamin B12 and folate deficiencies comprised 93.3% (n=168) and 6.67% (n=12), respectively. Combined deficiency comprised 1.11% (n=3) of cases. Mixed nutritional deficiencies comprised 22.78% (n=41) with normocytic anaemia exceeding macrocytic anaemia cases. A positive correlation between vitamin B12 and folate deficiencies and pancytopenias was observed. Of concern is the high prevalence of vitamin B12 and folate deficiencies without anaemia, 17% (n=31) and 1.11% (n=2), respectively. Only 2.22% (n=4) cases of vitamin B12 cases had records of anti-parietal and anti-intrinsic factor (IF) antibody assay results.
Conclusion
The study established a high prevalence of vitamin B12 deficiency as expected. However, the high prevalence of vitamin B12 and folate deficiencies without anaemia was unexpected, requiring a high clinical index of suspicion for early intervention. Furthermore, a normocytic anaemia should not prevent investigating for megaloblastic anaemia as mixed nutritional deficiencies could present with normocytic anaemia, and not macrocytic anaemia. Routine anti-parietal and anti-IF antibody testing is recommended for early identification of pernicious anaemia to allow prompt intervention.