title: Functional vitamin B12 deficiency in alcoholics: an intriguing finding in a retrospective study of megaloblastic anemic patients.
abstract: BACKGROUND
  Measurement of serum cobalamin levels is the standard investigation for assessing Vitamin B12 deficiency. However some patients with clinical evidence of cobalamin deficiency may have serum levels within the normal range. Since falsely increased values of cobalamin can be caused by alcoholic liver disease, we evaluated the impact of this disease on the diagnosis of cobalamin and folic acid deficiency.
  
  
  METHODS
  We reviewed data of 101 adult patients with megaloblastic anemia assessed by measuring in parallel serum cobalamin, serum folate and red blood cell folate levels. Further tests were performed in order to find the cause of megaloblastosis. All patients were treated with cobalamin and/or folic acid therapy.
  
  
  RESULTS
  Vitamin B12, folate and both deficiency were found in 86, 5 and 6 cases respectively. Normal cobalamin serum levels, normal serum and erythrocyte folate levels were found only in 3 patients, all alcohol-dependent, while in another alcoholic borderline vitamin B12 serum levels were found. All the four patients responded to cobalamin treatment.
  
  
  CONCLUSIONS
  Some alcohol-dependent patients with megaloblastic anemia may respond to vitamin B12 treatment despite normal cobalamin serum levels; therefore in alcoholics caution is urged in the interpretation of these vitamin assays, because of possible functional vitamin B12 deficiency.
authors.affiliation: Hematology Unit, Ospedale Madonna delle Grazie, ASM Matera, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fragasso
authors.forename: Clara
authors.initials: C
authors.lastname: Mannarella
authors.forename: Angela
authors.initials: A
authors.lastname: Ciancio
authors.forename: Andrea
authors.initials: A
authors.lastname: Sacco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications* / Q000378:metabolism; D000749:Anemia, Megaloblastic / Q000209:etiology*; D004912:Erythrocytes / Q000737:chemistry; D005260:Female; D005492:Folic Acid / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000209:etiology*; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D005492:Folic Acid; D014805:Vitamin B 12