title: Addition of cobalamin to iron and folic acid improves hemoglobin rise in nutritional anemia.
abstract: OBJECTIVE
  To assess whether addition of cobalamin (cbl) to iron-folic acid will result in improved response in nutritional anemia.
  
  
  METHODS
  This study included 150 children aged between 0.5-5 y having nutritional anemia. Anemia was categorized for severity and red cell morphology. Serum levels of ferritin were obtained in all cases while levels of cbl and folic acid (FA) were done only in children having macrocytic or dimorphic anemia. Children were randomized to receive either iron and FA (Group I) or iron, FA and cbl (Group II). Response to treatment was assessed at 2, 4 and 8 wk.
  
  
  RESULTS
  Of all the 150 patients, iron deficiency was documented in 111 patients. Of the 41 cases in whom, Cbl and FA levels were done, 97.56% and 53.66% had deficiency of cbl and FA respectively. Patients in group II had higher Hb level at 2, 4 and 8 wk (significant at 4 and 8 wk). Percentage Hb rise from baseline Hb was significantly higher in group II (p 0.00). In group II, increase in Hb among cases with macrocytosis and others were similar although percentage increase in Hb was more pronounced among patients with macrocytic anemia or dimorphic anemia. However, this difference was statistically not significant (p = 0.18).
  
  
  CONCLUSIONS
  Children receiving cbl in addition to iron and FA showed an improved hematological response.
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India. sudhach83@rediffmail.com
authors.forename: Sudha
authors.initials: S
authors.lastname: Chandelia
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chandra
authors.forename: Shashi
authors.initials: S
authors.lastname: Narayan
authors.forename: Satinder
authors.initials: S
authors.lastname: Aneja
authors.forename: Har Mohindra
authors.initials: HM
authors.lastname: Chawla
authors.forename: Sunita
authors.initials: S
authors.lastname: Sharma
authors.forename: Sarika
authors.initials: S
authors.lastname: Mrig
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications*; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000627:therapeutic use*
chemical_list: D006454:Hemoglobins; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12