Khalife Roy, Grieco Anthony, Khamisa Karima, Tinmouh Alan, McCudden Chris, Saidenberg Elianna
Division of Hematology, University of Ottawa, Canada.
Division of Hematology, University of Ottawa, Canada.
Blood Cells Mol Dis. 2019 May;76:40-44. doi: 10.1016/j.bcmd.2019.01.004. Epub 2019 Jan 24.
Scurvy is a rare entity in developed countries and the diagnosis may often be delayed resulting in unnecessary investigations and/or potentially severe complications. A recent increase in the number of patients diagnosed with scurvy in our hematology clinics indicated the need to review the literature on the diagnosis and optimal management of similar patients.
We conducted a retrospective chart review of patients referred to hematology at our tertiary care centre between 2010 and 2018, who were ultimately diagnosed with scurvy. Data collected from electronic medical records included baseline characteristics, clinical features on presentation, bloodwork results from initial consultation, treatment plan as well as response to treatment.
Twenty-two adults patient had a diagnosis of scurvy with a mean vitamin C level of 6 μmol/L. Iron deficiency anemia (54%) and gastrointestinal disorders (54%) were the most common comorbidities noted in our cohort. Proton-pump inhibitors use was noted in 54% of patients. Bleeding (45%) and bruising (45%) were the most commonly reported clinical features. Eleven patients received oral supplementation, five had intravenous (IV) vitamin C and six were not treated. Two patients required a transition from oral to IV supplementation. Vitamin C dosing ranged between 250 and 2000 mg and the frequency varied from daily for oral therapy to every few weeks or months for IV.
Awareness of scurvy and its associated risk factors and clinical presentation is important in the evaluation of a patient with bleeding tendency. Treatment plan should be individualized, and a careful review of patients' diet, medial history and medications is warranted.
坏血病在发达国家较为罕见，诊断往往会延迟，导致不必要的检查和/或潜在的严重并发症。近期我们血液科门诊诊断为坏血病的患者数量有所增加，这表明有必要回顾关于此类患者诊断和最佳管理的文献。
我们对2010年至2018年间转诊至我们三级医疗中心血液科且最终诊断为坏血病的患者进行了回顾性病历审查。从电子病历中收集的数据包括基线特征、就诊时的临床特征、初诊时的血液检查结果、治疗方案以及治疗反应。
22名成年患者被诊断为坏血病，平均维生素C水平为6微摩尔/升。缺铁性贫血（54%）和胃肠道疾病（54%）是我们队列中最常见的合并症。54%的患者使用过质子泵抑制剂。出血（45%）和瘀伤（45%）是最常报告的临床特征。11名患者接受口服补充剂，5名接受静脉注射维生素C，6名未接受治疗。2名患者需要从口服补充剂转为静脉注射补充剂。维生素C剂量在250至2000毫克之间，频率从口服治疗的每日一次到静脉注射的每隔几周或几个月一次不等。
在评估有出血倾向的患者时，了解坏血病及其相关危险因素和临床表现很重要。治疗方案应个体化，有必要仔细审查患者的饮食、病史和用药情况。
