BMC pediatrics · 2025
Elevated serum cobalamin levels in childhood: a retrospective analysis.
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Kalayci Furkan, Yigit Metin, Kalyoncu Arican Gozde Melisa, Gokdol Muhammed Yasin, Tekin Metehan Yasar, Kalayci Orhun Kerem, Celebier Kaan, Kacar Dilek, Yarali Nese
Аннотация
BACKGROUND: Cobalamin (Cbl) is a water-soluble vitamin. While its deficiency is well recognized, the clinical significance of elevated serum Cbl levels remains unclear, particularly in children. This study aimed to investigate the clinical and laboratory findings in pediatric patients with excessively high Cbl levels to identify potential underlying causes and outcomes.
METHODS: In this retrospective study, pediatric patients with serum Cbl levels > 1500 ng/mL at Ankara Bilkent City Hospital between January and May 2024 were evaluated. Clinical and laboratory data - including demographics, Cbl treatment, chronic disease history, lab results, and imaging - were analyzed.
RESULTS: A total of 388 patients (median age 6, 46.4% male) were included. Cbl treatment was reported in 45.4% of patients, and significantly higher Cbl levels were observed in this group (p < 0.001). Among those with chronic diseases, leukemia and tumors were the most common. Of the children with elevated Cbl levels, 81.3% were asymptomatic. Five patients with no known chronic diseases or history of supplementation at presentation were later diagnosed with rhabdomyosarcoma, AML, B-cell lymphoma, and CML. Ultrasonographic abnormalities, such as steatosis, hepatosplenomegaly, and increased renal echogenicity, were more frequently observed in patients with high Cbl levels (p = 0.013). Patients with chronic diseases exhibited higher Cbl levels and prolonged normalization periods (p < 0.001).
CONCLUSION: Although high serum Cbl levels in children are often incidental, persistently elevated levels without a clear cause may indicate serious underlying conditions, including malignancies. Close monitoring, further investigation, and avoidance of unnecessary Cbl supplementation are essential for appropriate clinical management.
METHODS: In this retrospective study, pediatric patients with serum Cbl levels > 1500 ng/mL at Ankara Bilkent City Hospital between January and May 2024 were evaluated. Clinical and laboratory data - including demographics, Cbl treatment, chronic disease history, lab results, and imaging - were analyzed.
RESULTS: A total of 388 patients (median age 6, 46.4% male) were included. Cbl treatment was reported in 45.4% of patients, and significantly higher Cbl levels were observed in this group (p < 0.001). Among those with chronic diseases, leukemia and tumors were the most common. Of the children with elevated Cbl levels, 81.3% were asymptomatic. Five patients with no known chronic diseases or history of supplementation at presentation were later diagnosed with rhabdomyosarcoma, AML, B-cell lymphoma, and CML. Ultrasonographic abnormalities, such as steatosis, hepatosplenomegaly, and increased renal echogenicity, were more frequently observed in patients with high Cbl levels (p = 0.013). Patients with chronic diseases exhibited higher Cbl levels and prolonged normalization periods (p < 0.001).
CONCLUSION: Although high serum Cbl levels in children are often incidental, persistently elevated levels without a clear cause may indicate serious underlying conditions, including malignancies. Close monitoring, further investigation, and avoidance of unnecessary Cbl supplementation are essential for appropriate clinical management.