Arun, R S (2011) Comparison of efficacy of oral versus intramuscular vitamin B12 supplementation for treatment of vitamin B12 deficiency and determination of cellular deficiency of vitamin B12 using serum homocysteine as a surrogate marker in patients with low normal serum vitamin B12 levels. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : There is a high prevalence of vitamin B12 deficiency in rural as well as urban population in India. The etiology and risk factors in our population has however, not been adequately studied so far. The diagnosis of vitamin B12 deficiency is hampered by the lack of a gold standard diagnostic test. Studies have shown that serum vitamin B12 levels do not accurately reflect its deficiency at a cellular level, especially in the low normal range. The cellular deficiency of vitamin B12 is associated with elevated homocysteine levels, which is an important risk factor for cardiovascular morbidity. AIMS AND OBJECTIVES : To compare the efficacy of oral versus intramuscular vitamin B12 supplementation for the treatment of vitamin B12 deficiency and to determine whether patients with low normal serum vitamin B12 levels have vitamin B12 deficiency at cellular level, using serum homocysteine as a surrogate marker. MATERIALS AND METHOD : Consecutive patients with vitamin B12 deficiency attending department of gastrointestinal sciences and satisfying the inclusion criteria during November 2009 to November 2010 were enrolled in a prospective randomized open label clinical trial to compare the efficacy of oral versus intramuscular treatment and followed up for 3 months. An intention to treat analysis was done using SPSS 16.0 software. Mann- Whitney U test was used for continuous variables and Fisher’s exact test for categorical data. For the cross sectional study to determine the cellular deficiency of vitamin B12 using serum homocysteine levels as surrogate marker, consecutive patients with a serum vitamin B12 <400pg/ml during the above study period were enrolled and Spearman’s correlational studies were used. RESULTS : 60 patients (44male,16 female) were randomized in 1:1 ratio into oral and intramuscular treatment groups. The intention to treat analysis revealed no significant difference in the treatment response between the study groups(p=0.06). The intramuscular treatment was three times costlier than oral therapy. The most common cause of vitamin B12 deficiency was pernicious anaemia. 74% of patients with low normal serum vitamin B12 levels had hyperhomocysteinemia suggestive of cellular vitamin B12 deficiency. CONCLUSIONS : Oral vitamin B12 supplementation is cheaper than and equally effective as intramuscular treatment for vitamin B12 deficiency. The most common etiology for vitamin B12 deficiency in a tertiary care hospital setting in India is pernicious anemia. A majority of patients with low normal serum vitamin B12 levels (200-400pg/ml) have hyperhomocysteinemia, suggestive of vitamin B12 deficiency at cellular level. Serum homocysteine is a useful ancillary test for the diagnosis of intracellular vitamin B12 deficiency in patients with low normal serum vitamin B12 levels. KEY WORDS : vitamin B12, homocysteine, randomized trial, intracellular deficiency.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | vitamin B12 supplementation ; oral ; intramuscular ; treatment ; vitamin B12 deficiency ; determination of cellular deficiency of vitamin B12 ; serum homocysteine ; surrogate marker ; patients ; low normal serum vitamin B12 levels. |
| Subjects: | MEDICAL > Gastroenterology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 14 Jul 2017 04:50 |
| Last Modified: | 14 Jul 2017 04:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1633 |
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