Vitamin E sufficiency in children with cholestasis: a comparison between erythrocyte peroxide hemolysis and serum alpha-tocopherol.

Vitamin E sufficiency was assessed in 19 children with chronic cholestasis by determining both erythrocyte peroxide hemolysis (EPH) and serum alpha-tocopherol (alpha-T) levels. Eight had normal alpha-T (1.19 +/- 0.67 mg/dl; normal greater than 0.5). The mean EPH in this group was 13.1 +/- 14.3% (normal less than 20%). The remaining 11 patients had low alpha-T levels (0.25 +/- 0.15 mg/dl) and elevated EPH (83.9 +/- 17.1%). Children found to be vitamin E deficient received either oral alpha-T (50-100 IU/kg per day) or parenteral alpha-tocopherol acetate in sesame oil every 2-4 wk (200-300 mg). This permitted serial monitoring of EPH and alpha-T. We found that normalization of the EPH was uniformly accompanied by normalization of the alpha-T level. However, normal alpha-T levels occurred with elevated EPH (between 20% and 80%) on 11 occasions. EPH greater than 80% correctly identified vitamin E deficiency in all cases. Hence, EPH is a satisfactory screening test of vitamin E sufficiently. When the EPH is less than 20%, the patient is vitamin E sufficient. Conversely, when the EPH is greater than 80%, the patient is vitamin E deficient. Serum alpha-T measurements are needed to determine vitamin E sufficiency when the EPH is greater than 20% and less than 80%.