Pseudodementia in a twenty-one-year-old with bipolar disorder and vitamin B12 and folate deficiency

A twenty-one-year-old female known to suffer from bipolar type 1 disorder developed features of a pseudodementia. Following prompt initial response to treatment with antidepressants, there was an early recurrence of cognitive impairment. Blood investigations confirmed a macrocytic anaemia and vitamin B12 and folate deficiencies. There was dramatic resolution of cognitive impairment after vitamin replacement. This suggested the occurence of a reversible nutritional dementia and reinforced the need to rule out secondary organic causes of psychiatric symptoms even in patients previously diagnosed with a primary psychiatric disorder.(Au)

Small bowel morphology in British Indian and Afro Caribbean subjects: evidence of tropical enteropathy

Distal duodenal biopsy specimens taken from 30 white, 35 Indian, and 20 Afro-Caribbean residents of West Birmingham during routine endoscopy for dyspepsia, were assessed by disecting microscopy and morphometry. Finger-shaped villi were significantly less frequent in the Indian and Afro-Caribbean subjects than in the white subjects when assessed by disecting microscopy (p<0.005), and both immigrant groups had decreased mucosal thickness (p<0.01), villous height (p<0.001), villous:crypt ratios (p<0.01) and enterocyte height (p<0.05) compared with the white group. In the Indian subjects villous height and villous:crypt ratios correlated significantly with the time since the last visit to the Indian subcontinent (p<0.005). Serum alkaline phosphatase values were significantly higher in the Indian subjects compared with the white (p<0.02), and serum globulins were increased in both the Afro-Caribbean and Indian subjects (p<0.01). There were no correlations between morphometric indices and body habitus or biochemical or haematological indices and the long term effect of the morphological changes is not clear. (AU)

Haemoglobin, iron, folate and vitamin B12 levels in pregnant and lactating women in Jamaica

An island-wide survey of 167 unselected pregnant or lactating Jamaican women revealed a 45 per cent incidence of iron deficiency anaemia during pregnancy and the first six months of lactation. A high incidence of eosinophilia, probably the result of intestinal parasitism, was noted. There was no evidence that folate deficiency contributed to the anaemia in these women although red cell folate levels fell throughout pregnancy and the first six months of lactation. Two women who had uncomplicated folate deficiency were not anaemic. Serum B12 levels were found to be considerably higher than those reported in European women during pregnancy and lactation and the lower levels were found in the second rather than the third trimester (AU)

Modern laboratory methods in clinical haematology: the assay of serum vitamin B12

A simple microbiological method for assaying vitamin B12 in serum is described and the levels in normal subjects, hospital patients without anaemia, ante-natal mothers, infants and patients with pernicious anaemia in Jamaica are recorded and compared (AU)

Urinary figlu and serum B12 levels in patients with anemia

In a study of 32 anaemic patients (Hb less than 7.5gm percent) it was found that all patients with normoblastic marrow had negative urinary figlus. No case of ankylostomiasis demonstrated deficiency of folic acid or B12. The survey is to continue wuth emphasis on th megaloblastic anaemias (AU)

Incidence and treatment of hookworm anaemia

Over a period of 49 months, 135 children were admitted to San Fernando Hospital, Trinidad, because of anaemia associated with hookworm infestation. Eight of these patients died. In 66 children given iron-dextram complex intramuscularly, satisfactory rise in hemoglobin levels was noted. It is felt that a daily dose of 50 mgm. was adequate for most cases and that neither dosage beyond this level nor vitamin B12 supplements enhanced this response any further. The clinical management is discussed and it is noted in passing that the incidence of this disease is now one-eight of what it was 5 years ago (AU)

Clinical studies on South Trinidadian children: (III) intramuscular iron in the treatment of hookworm anaemia

Results are presented to show that in the treatment of children with severe iron deficiency anaemia, associated with hookworm infection, intramuscular iron has proved so efficient that it is proposed to continue its use despite the present controversy about its ultimate effects. In the small groups of children investigated, it appeared that little benefit was derived from increasing the daily dose of iron from 50 to 100 or 200 mgms., or from adding vitamin B12 to the regime. It is suggested that a few grave cases, in whom haematinics were inadequate and simple blood transfusion dangerous, were saved by exchange transfusion.(AU)

Folic acid and vitamin B12 studies in megaloblastic anaemia of infancy (abstract only)

The clinical and haematological features of megaloblastic anaemia of infants are briefly reviewed. The results of assays of urinary formiminoglutamic acid on 12 infants are presented. Folic acid is required for the normal degradation of formiminoglutamic to glutamic acid and consequently in folic acid deficiency elevated levels of formiminoglutamic acid are found. The results indicate clearly that the disease is due to a deficiency of folic acid, and this is confirmed by the demonstration of normal vitamin B12 levels in the six infants in whom this assay was performed (AU)

Megaloblastic anaemia of infancy in Jamaica

The terms "megaloblast" and "megaloblastic anaemia" are defined. The megaloblast is a pathological cell and it is only found, specifically, in anaemias which are attributable to a deficiency of certain essential haemopoietic factors present in liver. The morphology of normoblasts and of megaloblasts, i.e. a cell with some of the characteristics of both a megaloblast and a normoblast, is discussed. The charateristic changes in the granulocytic series of cells, which are seen in megaloblastic anaemias, are discussed. The development of knowledge with regard to the essential haemopoietic factors present in liver is described, and the possible roles, and interrelationships of folic acid, folinic acid and vitamin B12 are discussed. It is concluded that, although their precise functions are still uncertain, there is no doubt as to their importance in nucleic acid synthesis. The literature on megaloblastic anaemia of infancy is reviewed. The rather rare association between infantile malnutrition and megaloblastic anaemia are discussed, and the fact that anaemia of any severe degree is unusual in kwashiorkor is stressed. The few available bone-marrow studies in kwashiorkor are described. A megaloblastic bone marrow has not very commonly been seen in kwashiorkor except in Durban, South Africa. A condition which resembles kwashiorkor very closely has been reported from Sicily. These infants are often very anaemic and a megaloblastic bone marrow is commonly seen. The clinical, haematological and other laboratory findings on fifty cases of megaloblastic anaemia of infancy are presented. From the clinical point of view the most striking feature was that all the infants were very malnourished and grossly under-weight. On haematological examination the best valuable finding from a diagnostic point of view was found to be the haemoglobin level. If this is below 7.0 g percent the anaemia is almost certainly going to be megaloblastic. A full blood count with determination of mean corpuscular volume, and haemoglobin concentration is rarely helpful since the anaemia is usually normocytic and normochronic. A certain diagnosis can be made by bone marrow puncture. Of the 50 cases, 45 were tested with folic acid, and 5 received vitamin B12. Six of the folic acid treated cases died. In the 39 folic acid treated who recovered, the haematological and clinical response was excellent. The 5 cases treated with vitamin B12 also showed a good haemotological and clinical response, although the dosage used was large. The majority of cases received antibiotics, and some received several, but in no case was a haematological response observed. The morphology of the bone marrow in haemaloblastic anaemia of infancy is described and extensively illustrated. In addition to typical megaloblasts, erythroblasts of intermediate type were commonly observed. The characteristic white cell abnormalities are also described. Changes in the nuclear chromatin structure of the megakaryocytes were also noted, which resemble the changes seen in megaloblasts quite closely. The post-mortem findings in the six fetal cases are summarized. Extramedullary erythropoiesis was observed in the livers of three cases, and in two a severe chronic fatty change was presented. In one case an acute fatty change was seen. The results of liver biopsies carried out on twelve other infants are also reported. Extra-medullary erythropoiesis was found in seven out of the ten specimens which were sectioned histologically. This finding of extra-medullary erythropoiesis is regarded as being pathognomonic of the disease, although it is not invariably present. Five cases of sickle cell anaemia with associated megaloblastic anaemia are described. This association has only been reported once before in infancy. Three other instances are recorded in the literature in older children. The association is highly significant, since a total of five cases out of fifty exceeds the expected incidence by no less than 3 times. An unexpected and unexplained finding was that three of these cases were also demonstrably iron deficient. The pathogenesis of the disease is considered in detail. It is thought that dietary deficiency is the most important factor, but whether of folic acid or vitamin B12 is uncertain. A deficiency of folic acid seems more likely. The possible significance of ascorbic acid deficiency in the aetiology of the disease is discussed, and the literature on the experimental production of megaloblastic anaemia in monkeys by means of a diet low in folic acid and deficient in ascorbic acid is reviewed. Only one infant in the present series had frank scurvy, and in this case ascorbic acid was required in addition to folic acid to produce a satisfactory haematological and clinical response. The importance of infection in the causation of the disease is discussed. Infections of various types were extremely common especially upper respiratory infections and gastro-enteritis. The role of gastro-enteritis is illustrated by six case in which specific pathogens were isolated from the stools. The possible mechanisms, which may be of importance in the causation of the disease, are listed: (1) A dietary deficiency of haemopoietic substance is thought to be the most significant factor. (2) An intrinsic factor deficiency is suggested speculatively as possibly playing a part. (3) Impaired absorption of haemopoietic factors due to diarrhoea is undoubtedly important. (4) Excessive utilization of haemopoietic factors by an abnormal bacterial flora in the intestine may contribute to a deficiency. (5) Diminished synthesis of haemopoietic factors by an abnormal bacterial flora in the intestine may also play a part. In conclusion some possible lines of future investigation of the disease are discussed (Summary)

The influence of certain factors, vitamin B12 and aureomycin, on the growth of protein-deficient children (abstract only)

A study was made to examine the influence of vitamin B12 and aureomycin upon the rate of growth in protein-deficient children. The results of this study present evidence for a slight positive effect of aureomycin upon the rate of weight increase, but no effect upon the rate of height increase. The results show that vitamin B12 has no positive effect upon the rate of height increase. The nutritional status was observed to be low. Among the observations made were clinical examinations, growth measurements, biochemical measurements and a direct dietary survey. There is no evidence to suggest that either aureomycin or vitamin B12 would be of practical value in alleviating the malnutrition found in such areas as the Caribbean (AU)

The influence of vitamin B12 and aureomycin upon the growth of protein deficient children

A study was made to examine the influence of vitamin B12 and aureomycin upon the growth in protein-deficient children. The results of this study present evidence for a slight positive effect of aureomycin upon the rate of weight increase, but no effect upon the rate of height increase. The result show that vitamin B12 has no positive effect upon weight or height increments. The nutritional status was observed to be low. Among the observations made were clinical examinations, growth measurements, biochemical measurements and a direct dietary survey. There is no evidence to suggest that either aureomycin or vitamin B12 would be of practical value in alleviating the malnutrition found in such areas as the Caribbean. (summary)