[en] We report a case of severe pancytopenia in a 15-year-old patient due to a severe deficiency in vitamin B12 and folic acid, probably of nutritional origin. The clinical and biological course was favorable after vitamin supplementation. With this case, we discuss the diagnostic approach of pancytopenia with megaloblastic anemia in children and adolescents, as well as the mechanisms involved in vitamin B12 and B9 deficiency. Hypovitaminosis B12 is known in its severe form but its diagnosis is often made difficult by insidious signs and symptoms. Traditional intramuscular replacement therapy has now proven to be effective orally. The clinical manifestations of folic acid deficiency are relatively similar to those of vitamin B12 deficiency, reflecting their intricate co-enzymatic functions. Its supplementation is administered orally.
Disciplines :
Pediatrics Hematology
Author, co-author :
DEPUIS, Zoé ; Centre Hospitalier Universitaire de Liège - CHU > > Service de pédiatrie
Freedman, M.H. The Pancytopenias. In Nelson Textbook of Pediatrics, 19th ed.; Kliegman, R., Stanton, B., Eds.; Elsevier Saunders: Philadelphia, PA, USA, 2011; pp. 1684–1692.
Mialou, V. Pancytopénie, Aplasie Médullaire: Arbre Diagnostique. Available online: https://pap-pediatrie.fr/hematologie/pancytopenie-aplasie-medullaire (accessed on 20 August 2021).
Bain, B.J.; Clark, D.M.; Wilkins, B.S. Disorders of Erythropoiesis, Granulopoiesis and Thrombopoiesis. In Bone Marrow Pathology, 5th ed.; John Wiley & Sons: Hoboken, NJ, USA, 2019; pp. 551–555.
Pine, M.; Walter, A.W. Pancytopenia in hospitalized children: A five-year review. J. Pediatr. Hematol. Oncol. 2010, 32, 192–194. [CrossRef] [PubMed]
Bhatnagar, S.K.; Chandra, J.; Narayan, S.; Sharma, S.; Singh, V.; Dutta, A.K. Pancytopenia in children: Etiological profile. J. Trop. Pediatr. 2005, 51, 236–239. [CrossRef] [PubMed]
De Lonlay, P.; Fenneteau, O.; Touati, G.; Mignot, C.; Billette de Villemeur, T.; Rabier, D.; Blanche, S.; Ogier de Baulny, H.; Saudubray, J.M. Manifestations hématologiques dans les erreurs innées du métabolisme. Arch. Pediatr. 2002, 9, 822–835. [CrossRef]
Whitehead, V.M. Acquired and inherited disorders of cobalamin and folate in children. Br. J. Haematol. 2006, 134, 125–136. [CrossRef] [PubMed]
Kneller, K. Les vitamines en pédiatrie. Rev. Med. Brux. 2012, 33, 339–345.
Rufenacht, P.; Mach-Pascual, S.; Iten, A. Hypovitaminose B12: Challenge diagnostique et thérapeutique. Rev. Med. Suisse 2008, 4, 2212–2217.
Bosco, C.; Favrat, B.; Cheseaux, M. Carences en vitamine B12 et fer: Du diagnostic au suivi. Rev. Med. Suisse 2012, 8, 1348–1351.
Verma, S. Incidence of vitamin B12 and folate deficiency amongst adolescents. Int. J. Contemp. Med. Res. 2017, 4, 1755–1757.
Dündar, M.A.; Torun, Y.A.; Celik, S.F.; Tartici, E.K.; Karakükçü, C. Increased asymmetric dimethylarginine in vitamin B12 deficient adolescents. Cardiol. Young 2019, 29, 190–194. [CrossRef]
Shipton, M.J.; Thachil, J. Vitamin B12 deficiency—A 21st century perspective. Clin. Med. 2015, 15, 145–150. [CrossRef]
Hannibal, L.; Lysne, V.; Bjorke-Monsen, A.L.; Behringer, S.; Grünert, S.C.; Spiekerkoetter, U.; Jacobsen, D.W.; Blom, H.J. Biomarkers and algorithms for the diagnosis of vitamin B12 deficiency. Front. Mol. Biosci. 2016, 3, 27. [CrossRef] [PubMed]
Serraj, K.; Mecili, M.; Andrès, E. Signes et symptômes de la carence en vitamine B12: Revue critique de la littérature. Med. Therap. 2010, 16, 13–20. [CrossRef]
Celik, S.F.; Celik, E. Subclinical atherosclerosis and impaired cardiac autonomic control in pediatric patients with vitamin B12 deficiency. Niger J. Clin. Pract. 2018, 21, 1012–1016. [CrossRef]
Sezer, R.G.; Akoglu, H.A.; Bozaykut, A.; Ozdemir, G.H. Comparison of the efficacy of parenteral and oral treatment for nutritional vitamin B12 deficiency in children. Hematology 2018, 23, 653–657. [CrossRef]
Verma, D.; Chandra, J.; Kumar, P.; Shukla, S. Efficacity of oral methylcobalamin in treatment of vitamin B12 deficiency anemia in children. Pediatr. Blood Cancer. 2017, 64, e26698. [CrossRef]
Devalia, V.; Hamilton, M.S.; Molloy, A.M. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br. J. Haematol. 2014, 166, 496–513. [CrossRef]
Roche, C.; Roche, N.C.; Thefenne, H.; Saidi, R.; De Pina, J.-J.; Molinier, S.; Oliver, M. Pancytopénie et carence en folates: À propos d’un cas. Ann. Biol. Clin. 2011, 63, 331–335. [CrossRef]
Selhub, J.; Morris, M.S.; Jacques, P.F.; Rosenberg, I.H. Folate-vitamin B-12 interaction in relation cognitive impairment, anemia, and biochemical indicators of vitamin B-12 deficiency. Am. J. Clin. Nutr. 2009, 82, 702–706. [CrossRef]
Pawlak, R.; Lester, S.E.; Babatunde, T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: A review of literature. Eur. J. Clin. Nutr. 2014, 68, 541–548. [CrossRef] [PubMed]
Gilsing, A.M.J.; Crowe, F.L.; Lloyd-Wright, Z.; Sanders, T.A.B.; Appleby, P.N.; Allen, N.E.; Key, T.J. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: Results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur. J. Clin. Nutr. 2010, 64, 933–939. [CrossRef] [PubMed]
Similar publications
Sorry the service is unavailable at the moment. Please try again later.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.