Remacha A F, Wright I, Fernández-Jiménez M C, Toxqui L, Blanco-Rojo R, Moreno G, Vaquero M P
Hematology Laboratory Department, Hospital Sant Pau, Barcelona, Spain.
Institute of Food Science Technology and Nutricion (ICTAN), CSIC, Madrid, Spain.
Int J Lab Hematol. 2015 Oct;37(5):641-8. doi: 10.1111/ijlh.12378. Epub 2015 May 11.
The relationship between iron deficiency and vitamin B12 and folate was recognized several decades ago. Combined deficiency is important in clinical practice owing to its relationship with malabsorption syndromes. By contrast, iron deficiency and low levels of serum vitamin B12 with normal metabolic markers were often found mostly in young adults. In this work, vitamin B12/folate changes were investigated during treatment of iron deficiency anaemia (IDA) with pharmacological iron in young adult women.
A cohort of 35 young adult women with IDA was treated with oral iron. An haematological response was obtained in 97.2% at 4-month follow-up. Changes in serum vitamin B12, serum folate and other biochemical parameters were monitored.
Treatment with iron increased significantly serum folate and vitamin B12 from baseline. This increase was also observed in vitamin B12 levels ≤200 pmol/L (six patients, 17.1%), in whom serum vitamin B12 was above 200 pmol/L at the end of the study in all cases. Other biochemical parameters also changed. Significant increases were seen for glucose (P = 0.012), uric acid (P < 0.001), total cholesterol (P = 0.023), HDL cholesterol (P = 0.026) and bilirubin (P < 0.001). Urea decreased significantly (P = 0.036).
Data from our work suggest that iron deficiency could affect many metabolic pathways, including vitamin B12, folate and lipids. These changes normalize after iron therapy, even in women with baseline low levels of serum vitamin B12. Healthcare practitioners should be aware of these changes in IDA management. The mechanisms controlling these changes remain to be explained, but they are probably related to the control of iron homeostasis (iron deficiency mediated stimuli).
缺铁与维生素B12和叶酸之间的关系在几十年前就已被认识到。由于其与吸收不良综合征的关系，联合缺乏在临床实践中很重要。相比之下，缺铁和血清维生素B12水平低且代谢指标正常的情况常见于年轻成年人。在这项研究中，对年轻成年女性缺铁性贫血（IDA）患者使用药物铁剂治疗期间维生素B12/叶酸的变化进行了研究。
对35名患有IDA的年轻成年女性队列给予口服铁剂治疗。在4个月的随访中，97.2%的患者获得了血液学反应。监测血清维生素B12、血清叶酸和其他生化参数的变化。
铁剂治疗使血清叶酸和维生素B12较基线水平显著升高。在血清维生素B12水平≤200 pmol/L的患者中（6例，17.1%）也观察到了这种升高，所有病例在研究结束时血清维生素B12均高于200 pmol/L。其他生化参数也发生了变化。葡萄糖（P = 0.012）、尿酸（P < 0.001）、总胆固醇（P = 0.023）、高密度脂蛋白胆固醇（P = 0.026）和胆红素（P < 0.001）显著升高。尿素显著降低（P = 0.036）。
我们的研究数据表明，缺铁可能会影响许多代谢途径，包括维生素B12、叶酸和脂质。即使是基线血清维生素B12水平较低的女性，铁剂治疗后这些变化也会恢复正常。医疗从业者在管理IDA时应注意这些变化。控制这些变化的机制仍有待解释，但可能与铁稳态的控制（缺铁介导的刺激）有关。
