Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
6-18 Yaş Arası Çocuklarda Nütrisyonel Vitamin B12 Eksikliğinde Oral Kobalamin Tedavisinin Etkinliğinin Retrospektif Değerlendirilmesi
A Retrospective Evaluation of the Effectiveness of Oral Cobalamine Treatment in Children Aged 6-18 Years with Nutritional Vitamin B12 Deficiency
Ali PEHLİVANa, Erol ERDURANb, Ayşenur BAHADIRb, Gökçe Pınar REİSb
aAkçaabat Haçkalı Baba Devlet Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, Trabzon, Türkiye
bKaradeniz Teknik Üniversitesi Tıp Fakültesi, Çocuk Hematolojisi ve Onkolojisi BD, Trabzon, Türkiye
Turkiye Klinikleri J Pediatr. 2023;32(1):8-17
doi: 10.5336/pediatr.2022-91251
Article Language: TR
Full Text
ÖZET
 Amaç: Oral yol ile verilen B12 vitamini tedavisi çocukların tedaviye uyumu için daha uygun bir seçenektir. Çalışmamızda, nütrisyonel B12 vitamini eksikliği olan, 6-18 yaş arası çocuklara uygulanan oral B12 vitamini tedavisinin [siyanokobalamin (Dodex ampul)® 1.000 μg/amp, oral yol ile aç karnına, ilk 1 hafta her gün 1.000 μg, daha sonraki hafta günaşırı 1.000 μg, ardından 2 hafta süresince haftada 2 gün 1.000 μg, takiben 4 ay süresince haftada bir gün 1.000 μg oral B12 idame tedavisi verilmiştir] 4 ay süresince haftada bir gün 1.000 μg olarak verilmesinin etkinliğinin retrospektif değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Karadeniz Teknik Üniversitesi Tıp Fakültesi, Pediatri ABD, Çocuk Hematoloji ve Onkoloji Bilim Dalında, Ocak 2010-Ocak 2018 tarihleri arasında B12 vitamini eksikliği tanısıyla takip ve tedavi edilen 6-18 yaş grubu hastaların dosyaları retrospektif olarak incelendi. Bulgular: En sık saptanan başvuru şikâyeti baş ağrısı (%28,8) idi. Hastaların %24,1'inde eritrosit dağılım genişliği yüksekliği, %18,8'inde anemi, %7,5'inde lenfopeni, %3,1'inde makrositoz, %2,8'inde nötropeni, %2,7'sinde trombositopeni ve %30,1'nde homosistein yüksekliği, %15,6'sında idrar metilmalonik asit yüksekliği bulunmuştur. Tedavi sonrası vitamin B12 seviyesi ve hemoglobin değerleri tedavi öncesine göre anlamlı derecede yüksek (p<0,05) saptanmakla beraber ortalama serum B12 seviyeleri 191,4 pg/mL (<200 pg/mL) olarak sonuçlandı. İdame tedavide, 4 ay süre ile verilen haftalık 1.000 mcg siyanokobalamin tedavisinin başarı oranı %27,7 idi. Sonuç: Oral yol ile verilen tedavinin etkili olmakla beraber, 6-18 yaş grubu hastalarda 4 aylık, haftada bir gün verilen idame tedavinin yeterli olmadığı kanaatine varılmıştır, bu nedenle oral yoldan verilecek B12 vitamini idame tedavisinin haftada bir günden daha sık verilmesinin uygun olacağı kanaatindeyiz.

Anahtar Kelimeler: B12 vitamini eksikliği; çocuk; oral tedavi
ABSTRACT
 Objective: Orally administered vitamin B12 treatment is a more suitable option for children to adapt to the treatment. In this study, it was aimed to retrospectively evaluate the effectiveness of oral vitamin B12 treatment [cyanocobalamin (Dodex ampoule)® 1,000 μg/amp, orally on an empty stomach, 1,000 μg every day for the first week, 1,000 μg every other day for the next week, then 1,000 μg twice a week for two weeks, then 1,000 μg once a week for 4 months oral B12 maintenance therapy] conducted on children aged 6-18 years with nutritional vitamin B12 deficiency. Material and Methods: The files of 6-18 age group patients who were followed up and treated with the diagnosis of vitamin B12 deficiency at Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology between January 2010 and January 2018 were analyzed retrospectively. Results: The most common complaint was: headache (28.8%). Patients were diagnosed with high red cell distribution width in 24.1%, anemia in 18.8%, lymphopenia in 7.5%, macrocytosis in 3.1%, neutropenia in 2.8% and thrombocytopenia in 2.7%. Homocysteine elevation was found in 30.1% and urinary methylmalonic acid elevation in 15.6% of the patients. Serum vitamin B12 levels which are evaluated after treatment and hemoglobin values increased. Although these values were found to be significantly higher (p<0.05) compared to the values before the treatment, the mean serum B12 levels were 191.4 pg/mL (<200 pg/mL). In maintenance treatment, the success rate of 1,000 mcg cyanocobalamin treatment given for 4 months, once-a-week was 27.7%. Conclusion: Although oral treatment is effective, it has been concluded that a 4-month, once-a-week maintenance treatment is not sufficient in 6-18 age group patients. Therefore, we believe that it will be more appropriate to offer an oral vitamin B12 maintenance treatment more frequently than once a week.

Keywords: Vitamin B12 deficiency; child; oral treatment
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