NM  Vol.2 No.2 , June 2011
Vitamin B12 Screening in Cervical Spine Surgery Patients
ABSTRACT
Introduction Vitamin B12 is very vital for the nervous system. Its deficiency can manifest with neurological symptoms like pain and paresthesias and in severe cases may cause not completely restorable neurological damage, especially in elderly patients. Methods The charts of 702 patients who underwent cervical spine surgery retrospectively reviewed and data collected . All patients were preoperatively seen by an internist who ordered Vit B12 levels for some of them. We used two thresholds for the diagnosis of vitamin B12 deficiency, 200 and 300 pg/mL as recommended by Yao et al. 1992. Data were also collected on gender, payor status, myelopathy, hemoglobin level, corpuscular parameters and glycosylated hemoglobin level (HbA1c). Vitamin B12 levels were compared between patients with HbA1c levels ≥ 6.1% and <6.1%. Differences between patients ≥ and < than the median age were studied. The median age of the patient cohort was 52. Results Hemoglobin level was recorded for 659 patients. Vit B12 levels were ordered for 291 patients only. Overall, 13.7% had decreased hemoglobin level (anemia), 30.2% had decreased Vit B12 levels by the 300 threshold, 6.9% had decreased Vit B12 levels by the 200 threshold, 6.3% decreased MCV (microcytosis), and 2.8% increased MCV (macrocytosis). Only four patients (0.7%), of whom older than 52, had decreased hemoglobin level and increased MCV (macrocytic anemia) and one patient (0.4%), who was also older than 52, had decreased hemoglobin level, increased MCV and Vit B12 level < 200 pg/mL (macrocytic anemia duo to Vit B12 deficiency). Dividing the patient sample into three age groups, <40, 40-59, and ≥ 60 years, we investigated the trend of cobalamin deficiency by age and found an increase in cobalamin deficiency after 40 from 0% to 7.4% (200 threshold). Uninsured patients (25%) using the 200 pg/mL threshold and workers’ compensation (54.5%) and uninsured patients (50.0%) had the highest rate of Vit B12 deficiency using the 300 pg/mL threshold. The few patients with macrocytic anemia (N=4) and macrocytic anemia due to Vit B12 deficiency (N=1) had health coverage. Conclusion Vit B12 deficiency in cervical spine surgery patients may not necessarily mean macrocytic anemia but may precede macrocytic anemia. Therefore, Vit B12 deficiency screening on the preoperative visit is warranted especially in uninsured or older patients or both. Preoperative treatment may be indicated and correlation with postoperative outcome is suggested for future research.

Cite this paper
nullA. Tolaymat, M. Abbara, M. Walid, M. Ajjan and J. Robinson Jr, "Vitamin B12 Screening in Cervical Spine Surgery Patients," Neuroscience and Medicine, Vol. 2 No. 2, 2011, pp. 149-153. doi: 10.4236/nm.2011.22021.
References
[1]   Loikas S, Koskinen P, Irjala K, Lo¨ ppo¨ nen M, Isoaho R, Kivel L, Pelliniemi T. Vitamin B12 deficiency in the aged: a population-based study Age and Ageing 2007; 36: 177–183.

[2]   Lewis P. Rowland and Bradford P. Worrall. Chapter 154. nutritional disorders: vitamin b12 deficiency, malabsorption, and malnutrition. Merritt's neurology 10th edition (2000). Lewis P. Rowland (editor). Lippincott Williams & Wilkins Publishers.

[3]   Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, Noblet-Dick M, Maloisel F, Schlienger JL, Blicklé JF. Vitamin B12 deficiency in elderly patients. CMAJ Aug, 2004; 171(3)

[4]   Dong A, Scott SC. Serum vitamin B12 and blood cell values in vegetarian. Ann. Nutr. Metab. 1982. 26 (4): 209–16.

[5]   Pflipsen MC, Oh RC, Saguil A, Seehusen DA,Topolski R, The Prevalence of Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study.JABFM .2009; 22(5).

[6]   Gilligan MA. Metformin and vitamin B12 deficiency. Arch Intern Med. 2002 Feb 25;162(4):484-5.

[7]   Yao Y, Yao SL, Yao SS, Yao G, Lou W. Prevalence of vitamin B12 deficiency among geriatric outpatients.J Fam Pract. 1992;35(5):524-8.

[8]   Goodman M, Chen XH, Darwish D. Are U.S. lower normal B-12 limits too low? Journal of the American Geriatrics Society, 1996 ; 44 (10), 1274-75.

[9]   Eggertsen R, Nilsson T, Lindstedt G, Lundberg PA, Kilander A, Lindgren A, Nystr?m E. Prevalence and diagnosis of cobalamin deficiency in older people. Journal of the American Geriatrics Society, 1996; 44 (10). 1273-74.

[10]   Healton EV, Savage DG, Brust JCN, et al: Neurologic aspects of cobalamin deficiency. Medicine 1991;70:229-244.

[11]   Herr KD, Norris ER, Frankel BL.Acute Psychosis in a Patient With Vitamin B12 Deficiency and Coincident Cervical Stenosis .Psychosomatics. 2002;43:234-236.

[12]   Smith R: Sudden onset of psychosis in association with vitamin B12 deficiency. Br Med J 1967; 3:34.

[13]   Dharmarajan TS, Adiga GU, Norkus EP. Vitamin B12 deficiency;Recognizing subtle symptoms in older adults. Geriatrics. 2003;58(3).

 
 
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