B12 Hypervitaminemia : a clinical update.

Abrar-Ahmad ZULFIQAR, Emmanuelle ANDRES

Abstract


High serum levels of vitamin B12 or cobalamin, also called B12 hypervitaminemia, is a significantly underestimated biological abnormality. According to the literature, some conditions include solid neoplasia (whether metastatic or otherwise) and, either acute or chronic, malignant haematological disorders are responsible to the appearance of B12 hypervitaminemia. Other causes include: mainly liver disorders and monoclonal gammopathy of undetermined significance and renal failure; more rarely, excess vitamin B12 intake, inflammatory and autoimmune diseases, and transient haematological abnormalities (secondary neutrophilia or eosinophilia). Paradoxically, functional deficits including cobalamin deficiency are often associated with B12 hypervitaminemia. We establish a focus on causes for a hypervitaminemia B12, according to the literature, including our work.


Keywords


Cobalamin; B12 hypervitaminemia ; Transcobalamin ; Neoplasia; Liver disorders

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References


Andrès E, Serraj K, Zhu J, Vermorken AJM. The pathophysiology of elevated vitamin B12 in clinical practice. QJM. 2013 Jun 1;106(6):505–15.

Chiche L, Jean R, Romain F, Roux F, Thomas G, Canavese S, et al. Implications cliniques de la découverte d’une hypervitaminémie B12 en médecine interne. Rev Médecine Interne. 2008 Mar;29(3):187–94.

Deneuville T, Mario N, Tiev K-P, Tolédano C, Josselin-Mahr L, Gain M, et al. Concentration plasmatique élevée de la vitamine B12 : un indicateur des maladies hépatiques ou tumorales ? Rev Médecine Interne. 2009 Jun;30:S73.

Chiche L, Mancini J, Arlet J-B. Hypervitaminémies B12 en médecine interne : résultats de l’étude BDOSE. Rev Médecine Interne. 2009 Dec;30:S377.

Serraj K, Mecili M, Housni I, Andrès E. High level of cobalamin: physiopathology, role and interest in clinical practice. Presse Médicale Paris Fr 1983. 2011 Dec;40(12 Pt 1):1120–7.

Rochat MC, Vollenweider P, Waeber G. Hypervitaminémie B 12 : implications cliniques et prise en charge. Rev Médicale Suisse. 2012 Oct 31;8(360):2072–4, 2076–7.

Fyfe FC, Madsen M, Hojrup P, Christensen EI, Tanner SM, de la Chapelle A, et al. The functional cobalamin (vitamin B12)-intrinsic factor receptor is a novel complex of cubilin and amnionless. Blood 2004; 103:1573–9

Solomon LR. Disorders of cobalamin (vitamin B12) metabolism: emerging concepts in pathophysiology, diagnosis and treatment. Blood Rev 2007; 21:113–30

Andres E, Vidal-Alaball J, Federici L, Loukili NH, Zimmer J, Kaltenbach G. Clinical aspects of cobalamin deficiency in elderly patients. Epidemiology, causes, clinical manifestations, and treatment with special focus on oral cobalamin therapy. Eur J Intern Med 2007; 18:456–62

Ermens AA, Vlasveld LT, Lindemans J. Significance of elevated cobalamin (vitamin B12) levels in blood. Clin Biochem 2003; 36:585–90

Bowen RA, Dowdell KC, Dale JK, Drake SK, Fleisher TA, Hortin GL, et al. Elevated vitamin B₁₂ levels in autoimmune lymphoproliferative syndrome attributable to elevated haptocorrin in lymphocytes. Clin Biochem. 2012 Apr;45(6):490-2

Brah S, Chiche L, Mancini J, Meunier B, Arlet J-B. Characteristics of patients admitted to internal medicine departments with high serum cobalamin levels: Results from a prospective cohort study. Eur J Intern Med. 2014 Jun;25(5):e57–e58.

Zulfiqar A.A, Sebaux A, Drame M, Pennaforte J.L, Novella J.L, Andres E. Hypervitaminemia B12 in elderly patients: Frequency and nature of the associated or linked conditions. Preliminary results of a study in 190 patients. European Journal of Internal Medicine 26 (2015) e63–e64

Carmel R. Extreme elevation of serum transcobalamin I in patients with metastatic cancer. N Engl J Med. 1975 Feb 6;292(6):282–4.

Carmel R, Eisenberg L. Serum vitamin B12 and transcobalamin abnormalities in patients with cancer. Cancer. 1977 Sep;40(3):1348–53.

Boisson F, Fremont S, Migeon C, Nodari F, Droesch S, Gerard P, et al. Human haptocorrin in hepatocellular carcinoma. Cancer Detect Prev. 1999;23(2):89–96.

Arendt JFB, Pedersen L, Nexo E, Sørensen HT. Elevated Plasma Vitamin B12 Levels as a Marker for Cancer: A Population-Based Cohort Study. J Natl Cancer Inst. 2013 Dec 4;105(23):1799–805.

Geissbühler P, Mermillod B, Rapin C-H. Elevated Serum Vitamin B12 Levels Associated With CRP as a Predictive Factor of Mortality in Palliative Care Cancer Patients: A Prospective Study Over Five Years. J Pain Symptom Manage. 2000 Aug;20(2):93–103.

Sviri S, Khalaila R, Daher S, Bayya A, Linton DM, Stav I, et al. Increased Vitamin B12 levels are associated with mortality in critically ill medical patients. Clin Nutr. 2012 Feb;31(1):53–9.

Kelly L, White S, Stone PC. The B12/CRP index as a simple prognostic indicator in patients with advanced cancer: a confirmatory study. Ann Oncol Off J Eur Soc Med Oncol ESMO. 2007 Aug;18(8):1395–9.

Carmel R, Hollander D. Extreme elevation of transcobalamin II levels in multiple myeloma and other disorders. Blood. 1978 Jun;51(6):1057–63.

Rachmilewitz D, Rachmilewitz EA, Polliack A, Hershko C. Acute promyelocytic leukaemia: a report of five cases with a comment on the diagnostic significance of serum vitamin B 12 determination. Br J Haematol. 1972 Jan;22(1):87–92.

Baz R, Alemany C, Green R, Hussein MA. Prevalence of vitamin B12 deficiency in patients with plasma cell dyscrasias: a retrospective review. Cancer. 2004 Aug 15; 101(4):790-5

Gimsing P. Cobalamin metabolism in chronic myelogenous leukemia. Dan Med Bull 1998; 45:459–79

Baker H, Leevy CB, DeAngelis B, Frank O, Baker ER. Cobalamin (vitamin B12) and holotranscobalamin changes in plasma and liver tissue in alcoholics with liver disease. J Am Coll Nutr. 1998 Jun;17(3):235–8.

Dou J, Xu W, Ye B, Zhang Y, Mao W. Serum vitamin B12 levels as indicators of disease severity and mortality of patients with acute‐on‐chronic liver failure. Clin Chim Acta. 2012 Nov 20;413(23–24):1809–12.

Molad Y, Rachmilewitz B, Sidi Y, Pinkhas J, Weinberger A. Serum cobalamin and transcobalamin levels in systemic lupus erythematosus. Am J Med. 1990 Feb;88(2):141–4.

Grindulis KA, Calverley M, Cox C. Rheumatoid arthritis: is serum vitamin B12 high in active disease? J Rheumatol. 1984 Apr;11(2):211–2.

Hofer LJ, Elian KM. Parenteral vitamin B12 therapy of hyperhomocysteinemia in end-stage renal disease. Med Clin Exp 2004; 27:10–3

Skouby AP, Hippe E, Olesen H. Antibody to transcobalamin II and B12 binding capacity in patients treated with hydroxocobalamin. Blood. 1971 Dec;38(6):769–74.

Hall CA, Wanko M. Increased transcobalamin I in a leukemoid reaction. J Lab Clin Med. 1971 Aug;78(2):298–301.

Reynolds EH, Bottiglieri T, Laundy M, Stern J, Payan J, Linnell J, et al. Subacute combined degeneration with high serum vitamin B12 level and abnormal vitamin B12 binding protein. New cause of an old syndrome. Arch Neurol. 1993 Jul;50(7):739–42.

Gale DP, Cobbold JF, Chataway J. Steroid-responsive functional B12 deficiency in association with transcobalamin II polymorphism 776C --> G. Eur J Haematol. 2006 Jan;76(1):75–8.

Teplitsky V, Huminer D, Zoldan J, Pitlik S, Shohat M, Mittelman M. Hereditary partial transcobalamin II deficiency with neurologic, mental and hematologic abnormalities in children and adults. Isr Med Assoc J IMAJ. 2003 Dec;5(12):868–72.

Gauchan D, Joshi N, Gill AS, Patel V, Debari VA, Guron G, et al. Does an elevated serum vitamin B12 level mask actual vitamin B(12) deficiency in myeloproliferative disorders? Clin Lymphoma Myeloma Leuk. 2012 Aug;12(4):269–73.

Lindenbaum J, Savage DG, Stabler SP, Allen RH. Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations. Am J Hematol 1990 Jun; 34(2): 99–107.




DOI: http://dx.doi.org/10.18103/imr.v4i6.734

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