YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==ANEMIA AND VITAMIN B-12== 6 AUTHOR Neve J TITLE [The nutritional importance and pharmacologic effects of cobalt and vitamin B 12 in man] SOURCE J Pharm Belg; VOL 46, ISS 4, 1991, P271-80 (REF: 72) ABSTRACT Cobalt is an unique trace element for man as it can only reveal its essential properties if provided directly as its biological active form, cobalamin or vitamin B12, the daily requirement of which is 1 to 2 micrograms in adults. This vitamin takes part in the activity of the enzyme methylmalonyl coenzyme A mutase, involved in the conversion of propionyl CoA to succinyl CoA, an intermediary product of the citrate cycle, and of the 5-methyltetrahydrofolate: homocystein methyltransferase, working in the metabolism of methionin and in DNA synthesis. Vitamin B12 deficiency is responsible for a megaloblastic anemia called pernicious anemia and for specific neurological disorders that can be corrected by adequate supplementation. Inorganic cobalt salts can therefore not be considered as essential micronutrients for man, but being able to induce polycythemia, they have a pharmacological property that was recommended in the treatment of various anemias, and they are also used in the management of cyanide poisoning. YOU ARE NOW CONNECTED TO THE MEDLINE (1994 - 97) FILE. 4 AUTHOR Field EA AUTHOR Speechley JA AUTHOR Rugman FR AUTHOR Varga E AUTHOR Tyldesley WR TITLE Oral signs and symptoms in patients with undiagnosed vitamin B12 deficiency. SOURCE J Oral Pathol Med 1995 Nov;24(10):468-70 ABSTRACT The oral manifestations of glossitis, stomatitis and mucosal ulceration in vitamin B12 deficiency have long been recognised. These oral changes may occur in the absence of symptomatic anaemia or of macrocytosis. The aim of this paper is to describe a retrospective study of the wide range of oral signs and symptoms reported by 14 patients found to have a previously undiagnosed vitamin B12 deficiency. None of the patients described in this study had generalised symptoms sufficiently advanced to arouse suspicions of vitamin B12 deficiency. The essential criteria for the diagnosis of pernicious anaemia are also discussed. 1 AUTHOR Markle HV TITLE Cobalamin. SOURCE Crit Rev Clin Lab Sci 1996;33(4):247-356 ABSTRACT Cobalamin (vitamin B12) is an essential nutrient derived exclusively from bacterial sources. It is an essential cofactor for three known enzymatic reactions. Untreated deficiency, caused by either the autoimmune disease pernicious anemia or nutritional lack, results in a macrocytic anemia and/or subacute combined degeneration of the spinal cord and is eventually fatal. Cobalamin in serum is bound to two proteins, transcobalamin and haptocorrin. The former is responsible for the essential delivery of cobalamin to most tissues. Inadequate tissue availability of cobalamin results in increased concentration of methylmalonic acid and homocyst(e)ine due to inhibition of methylmalonyl-CoA mutase and methionine synthase, respectively. Strict vegetarians have long been known to be at risk of cobalamin deficiency, which develops insidiously over many years. It is now clear that a significant number of the elderly and HIV-positive individuals are also at increased risk of deficiency. Any individual with reduced ability to split cobalamin from food-protein may also become deficient even though intrinsic factor is present. Diagnosis of cobalamin deficiency has frequently relied on total serum cobalamin and the Schilling test. Newer approaches such as analysis of methylmalonic acid, homocyst(e)ine, holotranscobalamin, anti-intrinsic factor antibodies, and serum gastrin may provide more cost-effective testing, as well as identify those with a covert deficiency. 14 AUTHOR de Rooij S AUTHOR van Bruggen R AUTHOR Thijssen C AUTHOR Hooijer C TITLE [Low serum vitamin B 12 level and vitamin B 12 deficiency in the elderly. When should supplement be provided?] SOURCE Tijdschr Gerontol Geriatr 1994 Mar;25(1):3-10 ABSTRACT Low serum vitamin B12 levels and vitamin B12 deficiencies are frequently found in the elderly. The full syndrome of a vitamin B12 deficiency is rather simple to diagnose. The large applicability of the vitamin B12 assay also gives rise to many probably incomplete features. Low/low-normal vitamin B12 levels in screening procedures raise uncertainty whether this finding represents deficiency and should be followed by supplementation. In this paper the occurrence of low serum levels of vitamin B12 are discussed. To assess the clinical relevance of low/low-normal outcomes supplementary diagnostic procedures will be needed. Within this scope we illustrate the d.o.s.-test and the MMA-assay. Especially the latter will probably provide more answers to the treatment question. Systematic research is needed to clarify this issue. Meanwhile supplementation of all low and low-normal outcomes of the B12-assay seems the best answer. 15 AUTHOR Pruthi RK AUTHOR Tefferi A TITLE Pernicious anemia revisited. SOURCE Mayo Clin Proc 1994 Feb;69(2):144-50 ABSTRACT OBJECTIVE: We discuss the pathophysiologic mechanisms, clinical features, diagnosis, and treatment of pernicious anemia (PA). DESIGN: A review of the clinical applications of the diagnostic and therapeutic progress of PA is presented. MATERIAL AND METHODS: A patient with PA may have a wide range of initial complaints that affect various organ systems or may be entirely asymptomatic. Hematologic variables may be normal in patients with cobalamin (Cbl) deficiency. Because of the difficulties in diagnosing Cbl deficiency, alternatives to measuring Cbl have been sought. Determining the urinary methylmalonic acid level is a less invasive, more practical, and, possibly, more sensitive method. The Schilling test is performed for assessment of the absorption of orally ingested radiolabeled crystalline cyano-Cbl; results should be interpreted cautiously. RESULTS: Vitamin B12 therapy should be lifelong. It is customarily administered intramuscularly. Other routes of administration have been studied. CONCLUSION: PA is one of the most treatable hematologic disorders.