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Platelet monoamine oxidase activity in megaloblastic anaemia.

Platelet monoamine oxidase activity has been measured in 17 patients with megaloblastic anaemia due to either vitamin B12 or folate deficiency, and in 20 healthy subjects. There was a highly significant increase in patients compared with controls. In two patients, platelet activity decreased following successful treatment. A significant correlation between platelet activity and the severity of bone marrow megaloblastic change, assessed by the deoxyuridine suppression test and bone marrow morphology, was also observed. If the change in activity also occurs in the nervous system, this may contribute to the mental disturbance associated with vitamin B12 or folate deficiency.

Anemia, Macrocytic↗

Folate nutrition is optimal in exclusively breast-fed infants but inadequate in some of their mothers and in formula-fed infants.

Plasma concentrations of folate were studied in a group of exclusively breast-fed infants and their mothers (their numbers gradually decreased from 200 at birth to 7 at 12 months) and in infants completely weaned to a cow's milk formula (containing 35 micrograms of folate/L) and solid foods. The exclusively breast-fed infants were in no danger of folate deficiency; their plasma levels were elevated after the age of 2 months and, on average, were 2.0-3.3-fold higher than maternal levels throughout the study. None of these infants had an inadequate plasma concentration, whereas up to 5% of the mothers had values less than or equal to 3 micrograms/L, despite supplementation during lactation with 0.1 mg folate/day. In the formula-fed infants, 69-94% of the plasma folate concentrations lay below the lowest concentration for the breast-fed infants. Although no infant had signs of anemia or macrocytosis in red cell indices, the infants weaned earliest had the lowest hemoglobin concentrations (p = 0.09) and the highest mean corpuscular volume (MCV) values (p = 0.06) at 9 months of age. Thus, an infant fed a formula containing the recommended amount of folate runs a risk of folate deficiency.

Age Factors↗

Effects of pregnancy and riboflavin deficiency on some aspects of iron metabolism in rats.

Using female Norwegian hooded rats on controlled dietary intakes we have looked at the effects of pregnancy, and of riboflavin status, on levels of circulating iron, hepatic ferritin, iron stores and iron mobilisation in vitro from ferritin. Results suggest that pregnancy, and rapid growth, increase the demand for iron turnover, and deplete ferritin stores, and that riboflavin deficiency may impair iron mobilisation for these purposes.

Animals↗

Value of estimating methylamalonic acid excretion in anaemia.

A rapid technique suitable for routine pathology laboratories has been used to estimate methylmalonic acid excretion in a 24-hour urine collection following a 10g. valine load. Levels above 40 mg./24 hours were found only in patients with vitamin B(12) deficiency. Patients with pernicious anaemia treated more than 24 hours before urine collection and patients with other types of anaemia had methylmalonic acid levels below 25 mg./24 hours.This method of demonstrating vitamin B(12) deficiency can be applied rapidly in debilitated patients so that specific treatment can be instituted within 36 hours of admission.

Adult↗

Diagnostic value of the serum folate assay.

The diagnostic value of the serum folate assay has been assessed in 90 patients, each of whom had a macrocytic anaemia and a low serum vitamin B(12) level. Twenty-nine (32%) patients were found to have anaemia due primarily to folate deficiency. The cause of the low serum vitamin B(12) levels is uncertain in the 22 (25%) patients with normal or borderline vitamin B(12) absorption. The effect of folic acid therapy was studied in four of these patients, and in each case the serum vitamin B(12) rose slowly to a normal level. The serum folate was low in only four (7.5%) of the 54 patients with pernicious anaemia, and the levels rose to normal on treatment with vitamin B(12) alone. A high serum folate occurred in eight (15%) pernicious anaemia patients. A normal serum folate indicated the diagnosis of pernicious anaemia or megaloblastic anaemia following partial gastrectomy. However, a normal serum folate and a very low vitamin B(12) level was found in two patients with idiopathic steatorrhoea. It is concluded that the serum folate assay is a valuable routine test in patients who have a macrocytic anaemia and low serum vitamin B(12). A low folate level makes the diagnosis of pernicious anaemia unlikely and is a strong indication for full investigation of small intestinal function.

Adult↗

Plasma and red cell folacin in cow's milk-fed infants and children during the first 2 years of life: the significance of boiling pasteurized cow's milk.

Plasma and red blood cell folacin concentrations (Lactobacillus casei activity) and other pertinent parameters have been studied in 10 infants and children fed home-made cow's milk mixtures until 5 months of age. The folacin concentrations have been estimated in 44 samples of pasteurized cow's milk before and after pretreatment with conjugase. The effect of boiling on the folacin concentration has been studied in 11 samples of pasteurized cow's milk. During the time the infants were fed home-made cow's milk mixtures they developed signs of folacin deficiency, as judged from the plasma and red cell folacin concentrations as well as from other hematologic studies. The mean folacin concentration in pasteurized cow's milk was 168.9 SEM 7.80, and range 72 to 262 nmol/liter. Pretreatment with conjugase did not increase the folacin concentrations. During boiling for 1 min 2/3 of the folacin activity was lost. This could be prevented by adding ascorbic acid, 1 mg/ml, before the boiling procedure. The folacin deficiency observed in the infants is probably secondary to loss of folacin activity in connection with the preparation of the cow's milk mixtures.

Adult↗

Folate deficiency presenting as pancytopenia in pregnancy.

Folate deficiency is a well-known complication of pregnancy. We present a case of folate deficiency with profound pancytopenia. Although this is a well-known consequence of folate deficiency, we wish to reemphasize this dramatic complication of pregnancy.

Adult↗