Diagnostic Associations of Hypercobalaminemia in Indian Population
Dr. Swarnima Singh,
Dr Ashok Kr Singh, East Boring Rd, Patna-800001, Bihar, India.
Introduction: Serum cobalamin (Cbl) measurements are routinely done to rule out its deficiency. Surprisingly, a high fraction of these patients display hypercobalaminemia.
Aim: To study hypercobalaminemia in hospital referred patients and their aetiological profile.
Materials and Methods: Samples received for Cbl measurement were divided into four groups as per their Cbl levels- low <200pmol/L, normal 200-600 pmol/L, high 601-1000 pmol/L and very high>1000 pmol/L. Surplus serum was further analysed for holotranscobalamin (holo TC) and Haptocorrin (HC).
Results: High Cbl was significantly associated with chronic alcoholism, liver disease and cancers. Patients with Cbl>1000 pmol/L showed higher risk of all cancer subtypes (myeloid, lymphatic, solid tumours); with highest risk for myeloid cancers. Distinctly higher median holo TC and HC levels were observed in groups with very high/high Cbl levels. Cancer, alcoholism, liver disease, renal, autoimmune and bronchopulmonary diseases showed HC above the reference range, the highest being that of cancer group.
Conclusion: High Cbl levels are as frequent as low cobalamin levels in clinical practice, and merits a full diagnostic work up. Cancer (especially myeloid), chronic alcoholism, liver disease have showed consistent association with high Cbl and HC levels.
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