Dapueto Gabriel, Vomero Alejandra, García Loreley
Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Andes Pediatr. 2022 Jun;93(3):410-415. doi: 10.32641/andespediatr.v93i3.3506.
In infants, vitamin B12 deficiency is mainly due to nutritional deficiencies related to maternal deficit. Most cases of maternal deficiencies are associated with vegetarian diets. Pernicious anemia is an au toimmune disease that affects the absorption of this vitamin. Although it is less common than nutri tional deficiency, is also an important cause of maternal deficiency.
to report a case of an infant with vitB12 deficiency, secondary to pernicious anemia in his mother, and to review the most important aspects of this disease in childhood.
Nine months-old male infant, without pathological perinatal history, exclusively breastfed, with persistent rejection of solid food from 6 months of age. One month before hospitalization, he progressively presented hyporesponsiveness, with fluctuating state of alertness, regression of motor development milestones, and vomiting. The blood count showed macrocytic anemia and neutropenia. Vitamin B12 deficiency was confirmed in the patient. He received treatment with intramuscular vitamin B12 with good clinical and laboratory response. Maternal B12 deficiency was confirmed as the cause of the infant's deficiency. Since the mother reported no dietary restrictions, anti-intrinsic factor and anti-parietal cell antibodies were measured, leading to the diagnosis of pernicious anemia.
Early recognition is essential to prevent the development of potentially irreversible neurological damage. Maternal pernicious ane mia should be considered in children with megaloblastic anemia, especially in those whose mothers do not follow vegetarian diets.
在婴儿中,维生素B12缺乏主要是由于与母亲缺乏相关的营养缺乏。母亲缺乏的大多数情况与素食饮食有关。恶性贫血是一种影响这种维生素吸收的自身免疫性疾病。虽然它比营养缺乏少见,但也是母亲缺乏的重要原因。
报告一例因母亲患恶性贫血继发维生素B12缺乏的婴儿病例,并回顾该疾病在儿童期的最重要方面。
一名9个月大的男婴,无围产期病理史,纯母乳喂养,自6个月大起持续拒绝固体食物。住院前一个月,他逐渐出现反应迟钝,意识状态波动,运动发育里程碑倒退,以及呕吐。血常规显示大细胞性贫血和中性粒细胞减少。患者维生素B12缺乏得到确诊。他接受了肌肉注射维生素B12治疗,临床和实验室反应良好。母亲维生素B12缺乏被确认为婴儿缺乏的原因。由于母亲报告没有饮食限制,检测了抗内因子和抗壁细胞抗体,从而诊断为恶性贫血。
早期识别对于预防潜在的不可逆神经损伤的发展至关重要。患有巨幼细胞性贫血的儿童,尤其是其母亲不遵循素食饮食的儿童,应考虑母亲患恶性贫血的情况。