Albai Oana, Timar Bogdan, Paun Diana Loreta, Sima Alexandra, Roman Deiana, Timar Romulus
Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Department of Diabetes and Metabolic Diseases, "Pius Brinzeu" Emergency Hospital, Timisoara, Romania.
Diabetes Metab Syndr Obes. 2020 Oct 21;13:3873-3878. doi: 10.2147/DMSO.S270393. eCollection 2020.
Vitamin B12 (cobalamin) deficiency is a frequent cause of megaloblastic anemia, manifested through various symptoms. Screening for this deficiency can be justified in case of patients with one or more risk factors present from the following: gastric resections, inflammatory bowel disease, use of metformin over a prolonged period of time, administration of proton pump inhibitors or H2 histamine receptor blockers for more than 12 months and in case of adults over 75 years of age. One method of determining vitamin B12 deficiency is measuring its serum levels, as well as performing measurements of serum levels of methylmalonic acid and homocysteine levels, which experience an increase in the early stages of vitamin B12 deficiency.
We bring to your attention, the case of a 62 years old patient diagnosed with Type 2 Diabetes Mellitus in 2015 that presented in the emergency room in October 2019 with an altered general condition, nausea, vomiting, abdominal pain, palpitation, and dyspnea. Treatment with metformin was initiated from the diagnosis of Type 2 Diabetes Mellitus, four years before. Investigations established the diagnosis of megaloblastic anemia by vitamin B12 deficiency. The symptoms disappeared after the injection of vitamin B12.
Periodical dosing of vitamin B12 should be performed in the case of patients with Type 2 Diabetes Mellitus treated with metformin, especially if they associate anemia and/or peripheral diabetic polyneuropathy.
维生素B12（钴胺素）缺乏是巨幼细胞贫血的常见原因，可通过多种症状表现出来。对于存在以下一种或多种风险因素的患者，进行这种缺乏症的筛查是合理的：胃切除术、炎症性肠病、长期使用二甲双胍、使用质子泵抑制剂或H2组胺受体阻滞剂超过12个月以及75岁以上的成年人。确定维生素B12缺乏的一种方法是测量其血清水平，以及测量血清甲基丙二酸水平和同型半胱氨酸水平，这些指标在维生素B12缺乏的早期阶段会升高。
我们提请您注意这样一个病例，一名62岁的患者于2015年被诊断为2型糖尿病，2019年10月因全身状况改变、恶心、呕吐、腹痛、心悸和呼吸困难而到急诊室就诊。该患者自四年前被诊断为2型糖尿病以来一直在接受二甲双胍治疗。检查确诊为维生素B12缺乏所致的巨幼细胞贫血。注射维生素B12后症状消失。
对于接受二甲双胍治疗的2型糖尿病患者，应定期补充维生素B12，尤其是当他们伴有贫血和/或糖尿病周围多发性神经病变时。
