Vitamin B12 deficiency presenting as pancytopenia in pregnancy: a case report
Vitamin B12 deficiency is a well-known cause of megaloblastic anaemia and pancytopenia. However, the incidence in pregnancy is rarely reported. We present a case of a 32-year old multigravid woman who was diagnosed with megaloblastic anaemia since 22 weeks gestation and progressed to develop severe pancytopenia at 30 weeks gestation. She was also diagnosed with vitamin B12 deficiency related to dietary and sociocultural habits. Folate and iron levels were normal throughout pregnancy. Treatment with parenteral cyano-cobalamin resulted in sustained improvement of haematological parameters. The pregnancy was carried to term and the baby was born weighing 2,050gm but otherwise well at birth and had normal developmental milestones thereafter. This case illustrates the clinical presentation of maternal vitamin B12 deficiency and demonstrates the importance of detecting and treating maternal vitamin B12 deficiency during pregnancy in at-risk patients. Failure to diagnose and institute treatment carries significant risks to both mother and child. Oral vitamin B12 supplementation should be considered for patients who are strictvegetarians or consume very little animal products.
Cikot RJL, Steegers-Theunissen RPM, Thomas CMG, et al. Longitudinal vitamin and homocysteine levels in normal pregnancy. Br J Nutr. 2001;85:49–58.
Guerr-Shinohar EM, Paiva AA, Rondo PH, et al. Relationship between total homocysteine and Draft 50 folate levels in pregnant women and their newborn babies according to maternal serum levels of vitamin B12. Br J Obstet Gynaecol. 2002;109:784–791.
Yusufji D, Mathan VI, Baker SJ. Iron, folate and Vitamin B12 nutrition in pregnancy.:A study of 1000 women from Southern India. Bull WHO 1973;48:15.
Muthayya S, Kurpad AV, Duggan CP et al. Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians. Eur J ClinNutr2006;60:791–801.
Yajnik CS, Deshpande SS, Jackson AA, Refsum H, Rao S, Fisher DJ et al. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: The Pune MaternalNutrition Study. Diabetologia 2008;51:29–38.
Refsum H. Folate, vitamin B12 and homocysteine in relation to birth defects and pregnancy outcome. Br J Nutr. 2001;85:S109–S113.
Graham SM, Arvela OM, Wise GA. Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants. J Pediatr. 1992;121:710–714.
Ishak R, Hassan K. The increasing importance of vitamin B12 deficiency as a contributing factor to anemia in Malaysia. Southeast Asian J Trop Med Public Health. 1994;25(3):457-458.
FAO/WHO. Vitamin and mineral requirements in human nutrition, 2nd ed. Geneva, World Health Organization, 2005.