Low Cobalamin Levels in African Americans with and without Sickle Cell Disease RESULTS

Demographics

Demographics and prevalence of low-serum-cobalamin-level patients are shown in Tables 1 and 2. The mean age of the 105 SCD patients screened for cobalamin levels was 36.4 ±13.3 years. The 112 non-SCD patients with anemia who were screened were significantly older (mean age 58.4 ± 15.4 years). Thirty-nine SCD patients were males (mean age 34 years) and 66 were females (mean age 34 years). In SCD patients with low В12 levels, the Hb types were: 12 homozygous SCD (SS), four Hb SCD and three sickle-fi-thalassemia. In the non-SCD patient group, 51 were males (mean age 56 years) and 61 were females (mean age 61 years).

The mean cobalamin level of the screened SCD population was significantly lower (496 ±352 pg/ml) than that of the screened non-SCD patients (869 ± 660 pg/ml, p O.0001). The frequency of low cobalamin levels was 18.1% (19/105) and 9.8% (11/112) in SCD and non-SCD patients, respectively (%2=3.11, nonsignificant). The mean ages of the low-cobalamin SCD and non-SCD patients were 28.1 ± 7.8 and 62.9 ± 16.2, respectively. The maleifemale ratios were 11:8 and 2:9, respectively, in SCD and non-SCD patients with low cobalamin. celebrex heart attack

Table 1. Age and sex distribution of patients with and without sickle cell disease screened for low serum cobalamin levels

SCD (N=105)

Non-SCD (N=112)

P Value
Female Mean age 66 (63%) 36.4 ± 13.3 61(54%) 58.4 ± 15.4
Mean cobalamin levels (pg/ml) (normal 200-950) 496 ± 352

869 ± 660

<0.001
Low cobalamin levels

NS: not significant

19 (18.1%)

11 (9.8%)

NS

Neurological Manifestations

None of the low-cobalamin SCD patients had neurological manifestations. In contrast, nine of the 11 non-SCD patients with low cobalamin levels had neurological findings. Among these nine patients, four had focal neurological deficits, one had blindness, one had aphasia and two, who also had diabetes, had coexistent neuropathy. Another two patients manifest­ed with neuropathy and dementia, two patients had urinary incontinence, one patient had a seizure disorder and two patients had no neurological manifestations (Figure 1). Of the two patients with no neurological problems, one had history of HIV and the other had coronary artery disease. Get the medication you need. Buy actos pioglitazone online

Figure 1. Neurological manifestations in non-SCD patients with low serum-Bi2 levels

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Etiology and Risk Factors of Low-Cobalamin Level Patients

Of the 19 SCD patients with low cobalamin levels, four had pernicious anemia, one had peptic ulcer and was on H2 blockers and one had pancreatic insufficiency and alcohol abuse. Among the 11 low-cobalamin non-SCD patients, four had pernicious anemia, one was on proton pump inhibitor and vitamin C, one had gastritis and one had peptic ulcer and was on H2 blockers. Thus, the proportion of SCD patients with unexplained (i.e., without risk factors) low cobalamin levels (13:19) was higher than that in non-SCD patients (4:11, %=2.92, nonsignificant). Going without your pills? Buy skelaxin online

Table 2. Characteristics of low serum cobalamin patients with and without SCD

SCD (N=19)

Non-SCD (N=11)

P Value

Male

Mean age (years)

11 (58%) 28.1 ± 7.8 2 (18%) 62.9 ± 16.2 O.05
Mean cobalamin levels (pg/ml) (normal 200-950) 150 155.5 NS
MMA levels (pmol/ml) (normal <0.41) 0.168 ±0.084 (N=7) 24.18±26.16 (N=5)
Homocysteine (micromoles/L) (normal 4-15)

NS: not significant

8.46 ± 3.97 (N=6) 15.5 ± 12.8 (N=5) NS

Laboratory Values

The mean cobalamin levels in low-cobalamin patients with SCD and non-SCD were 150 pg/ml and 155.5 pg/ml, respectively. We found that the mean serum methylmalonic acid (MMA) levels and homocysteine levels were higher in non-SCD patients (24.18 ±26.16 pmol/ml and 15.5 ± 12.8 micro-moles/L, respectively) when compared to those in SCD patients (0.168 ± 0.084 and 8.46 ± 3.97, respectively). However, results for MMA and homocysteine levels were available only in about half of the patients. At diagnosis, the Hb levels were similar in both groups. In the SCD group, the mean Hb value was 9.42 ± 1.84 g/dl and it was 9.7 ± 1.76 g/dl in the non-SCD patients. The average MCV was 92.1 and 98.1 fl in patients with and without SCD, respectively. Mean leukocyte count was 13.4 and 5.8 x 1,000/mm in SCD and non-SCD patients, respectively (Figure 2). Need medication you can’t afford? Buy discount imitrex

Figure 2. Laboratory parameters in low-serum-cobalamin patients with and without SCD

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Category: Diseases / Tags: cobalamin (B12), methylmalonic acid, sickle cell disease

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