Anaemia: cobalamin deficiency was common in elderly patients.

Clinical bottom line (level 4)

  1. A sixth of elderly patients attending an outpatient clinic had cobalamin deficiency.
Pennypacker et al: Journal of American Geriatric Society 1992; 40 (12): 1197-1204
Expires June 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: outpatient geriatric clinics, Veterans' Affairs centre and university hospital, USA

152 patients (aged range 65 to 99 years; mean 80, 88% male) consecutive and elderly

Excluded if
  • known cobalamin deficiency
  • chronic renal insufficiency (creatinine >3.0 mg/dl)





    • Outcomes studied:
  • cobalamin deficiency

    • Serum cobalamin levels < or = 300 pg/ml and elevated serum methylmalonic acid or homocysteine (>3 SD), were used to diagnose cobalamin deficiency.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    cobalamin deficiency ? 22/152 14.5%
    (8.88% to 20.1%)

    Comments

    1. Other studies have hinted that more profound b12 deficiencies lead to greater physical and cognitive symptoms.
    2. Other studies have suggested that normal serum cobalamin levels do not exclude pernicious anaemia; the prevalence of true cobalamin deficiency may be higher than identified.

    Citation

    1. Pennypacker LC, Allen RH, Kelly JP, et al: High prevalence of cobalamin deficiency in elderly outpatients. Journal of American Geriatric Society 1992; 40 (12): 1197-1204
    Search Terms: reference from review article
    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer: Daniel Sontheimer

    Clinical Question.
    Patient elderly
    Intervention or Exposure prevalence
    Outcome cobalamin deficiency