Jarosz Malgorzata, Irga Ninela, Wierzba Jolanta
Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii, Akademia Medyczna, Debinki 7, 80-211 Gdańsk, Poland.
Med Wieku Rozwoj. 2004 Apr-Jun;8(2 Pt 1):283-8.
Vitamin B(12) stores at birth are adequate for infants until the end of the first year of life even if it 's concentration in maternal breast milk is low. However, there are some situations in which infants have depleted vitamin B(12) stores and in addition have a low dietary intake of cobalamin. Vitamin B(12) depletion occurs in infants who are exclusively breastfed by mothers who have unrecognized pernicious anemia or are strict vegetarians for many years. In those infants symptoms of bone marrow disfunction and impaired development of the central nervous system appear already in the first months of life. Unrecognized cobalamin deficiency may lead to serious neurologic consequences, and even to the death of the child. The authors present a case of a 7.5 month old girl admitted to the Department of Paediatrics, Haematology, Oncology and Endocrinology. Gdańsk Medical University suspected of acute leukaemia. Based on a detailed diagnostic procedure a final diagnosis of vitamin B(12) deficiency anaemia was established. The child was exclusively breast-fed. Results of investigations into the reason for cobalamin deficiency in the patient s organism. Led to the diagnosis of pernicious anaemia in the mother. Such a suspicion had been made during pregnancy, but no continuation of investigations nor appropriate treatment were implemented. After treatment with vitamin B(12) supplements and modification of the diet the patient improved quickly and remarkably. A few months follow-up was enough to observe remarkable improvement of psychomotor development of this child.
出生时的维生素B12储备对婴儿来说足够维持到一岁末,即使其在母乳中的浓度较低。然而,在某些情况下,婴儿的维生素B12储备会耗尽,而且钴胺素的膳食摄入量也很低。维生素B12耗竭发生在由患有未被识别的恶性贫血的母亲纯母乳喂养的婴儿或多年严格素食的母亲所生的婴儿身上。在这些婴儿中,骨髓功能障碍和中枢神经系统发育受损的症状在出生后的头几个月就已出现。未被识别的钴胺素缺乏可能导致严重的神经后果,甚至导致儿童死亡。作者介绍了一名7.5个月大的女孩的病例,该女孩被送往格但斯克医科大学儿科、血液学、肿瘤学和内分泌学系,疑似患有急性白血病。基于详细的诊断程序,最终确诊为维生素B12缺乏性贫血。该儿童为纯母乳喂养。对患者机体钴胺素缺乏原因的调查结果,导致诊断其母亲患有恶性贫血。怀孕期间曾有过这样的怀疑,但未继续进行调查,也未实施适当的治疗。在用维生素B12补充剂治疗并调整饮食后,患者迅速且显著地好转。几个月的随访就足以观察到这个孩子的精神运动发育有显著改善。