비타민 B12 결핍성빈혈 환자에서 임상결과 분석 사례연구

Abstract

Vitamin B12 deficiency is a common cause of megaloblastic anemia with a variety of neuropsychiatric symptoms, and elevated serum homocysteine level in the elderly. Vitamin B12deficiency anemia is an uncommon disease, therefore the causes and clinical findings have not been well documented in Korea since 2006. This study was to analyze the causes and clinical characteristics of vitamin B12 deficiency anemia. We retrospectively analyzed the clinical data in electronic medical records for 15 Korean patients with vitamin B12 deficiency anemia who were diagnosed during the period from January 2006 to December 2011 at the Regional University Hospital in Korea. For treatment, we gave an intramuscular injection of hydroxycobalamin 1,000 μg(everyday for the first week, and once a week for the next 4 weeks, then once in 1~3 months), and used oral iron supplements for anemia with iron deficiency. Response to the therapy was evaluated by blood test and medical history hearing. The median age of the patients was 63.4 years and the male/female ratio was 2.75. The initial symptoms on admission were dyspnea(80%), general weakness(80%), glossitis(47%) and neurologic symptoms(27%). Ten cases had undergone gastrectomy, one case a small bowel operation and three cases had pernicious anemia. The median hemoglobin level was 7.5 g/dl(4.9~12.1), Mean corpuscular volume 103.2 fL(62.3~122.6), serum vitamin B12 level 74.9 pg/mL(54.5~96). Two case,which showed low serum ferritin level, were combined with iron deficiency anemia. The symptoms and laboratory abnormalities were normalized in 1~2 months after hydroxycobalamin treatment. No adverse side effects related to intramuscular injection are observed. We found that the gastrectomy was the common cause of vitamin B12 deficiency anemia after 2006 in Korea. All patients, who were treated by intramuscular injection of hydroxycobalamin,showed the normalized hemoglobin levels within 2 months of treatment. Initial symptoms,including dyspnea, general weakness, glossitis and paresthesia, showed an improvement within a week and subsided in a month.