Vitamin B12 and folate levels increase during treatment of iron deficiency anaemia in young adult woman

Introduction: The relationship between iron deficiency and vitamin B12 and folate was recognized several decades ago. Combined deficiency is important in clinical practice owing to its relationship with malabsorption syndromes. By contrast, iron deficiency and low levels of serum vitamin B12 with normal metabolic markers were often found mostly in young adults. In this work, vitamin B12/folate changes were investigated during treatment of iron deficiency anaemia (IDA) with pharmacological iron in young adult women. Methods: A cohort of 35 young adult women with IDA was treated with oral iron. An haematological response was obtained in 97.2% at 4-month follow-up. Changes in serum vitamin B12, serum folate and other biochemical parameters were monitored. Results: Treatment with iron increased significantly serum folate and vitamin B12 from baseline. This increase was also observed in vitamin B12 levels <= 200 pmol/L (six patients, 17.1%), in whom serum vitamin B12 was above 200 pmol/L at the end of the study in all cases. Other biochemical parameters also changed. Significant increases were seen for glucose (P = 0.012), uric acid (P < 0.001), total cholesterol (P = 0.023), HDL cholesterol (P = 0.026) and bilirubin (P < 0.001). Urea decreased significantly (P = 0.036). Conclusions: Data from our work suggest that iron deficiency could affect many metabolic pathways, including vitamin B12, folate and lipids. These changes normalize after iron therapy, even in women with baseline low levels of serum vitamin B12. Healthcare practitioners should be aware of these changes in IDA management. The mechanisms controlling these changes remain to be explained, but they are probably related to the control of iron homeostasis (iron deficiency mediated stimuli).