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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109

Volume 10, Issue 1, February 2014 pp 176-178

Case Report

Vitamin B12 Deficiency in 8 Month-Old Infant Born to a Rural Mother Who is a Pure Vegan

Suguna S.

Academic Editor : Dr. Aher K.R.

Background: In infants, vitamin B12 deficiency may be due to dietary deficiency born to mothers who are pure vegans. Case presentation: 8 month old male baby, single child born out of non consanguineous marriage with birth history, immunization history and developmental history being normal. Baby was exclusively breast fed till 6months of age, now on complementary feeds and mother is continuing breast feeding. Both mother and father are pure vegans. On examination, severe pallor was noted. Anthropometry was within normal range. Hyper pigmentation was noted in the knuckles and nail beds of fingers and toes. Hb %- 7.8g, PCV- 21, RBC count-2.1 million/cmm, total count- 6200cells/cmm, neutrophil count-17%, lymphocytes-72%, eosinophils- 11%. platelet count- 3.44Lakh cells/cmm, MCV- 97fl, MCH-35pg, MCHC- 36%, reticulocyte count- 0.3%,peripheral smear- RBCs were reduced in number with severe degree of anisocytosis, macrocytic normochromic cells, macroovalocytes, few polychromatophilic cells and ovalocytes were seen admixed with normocytic and normochromic cells. WBCs were normal in number, with lymphocytic predominance, few hypersegmented nutrophils were present. Platelets were adequate in number with normal morphology. Iron profile showed, S. iron- 35.8µg/dl, TIBC- 305 µg/dl, ferritin- 76.9ng/mL. Serum folic acid- > 24ng/ml (normal- >5.38ng/ml), serum cyanocobalamine; vitamin B12- 101pg/ml ( normal 211-911pg/ml). Stool for occult blood negative. Since parents are pure vegans, mother’s serum B12 level was done. Serum B12 level was reduced. The child was diagnosed as having vitamin B12 deficiency due to nutritional inadequacy and was treated with intramuscular vitamin B12 injections, and folic acid supplementation. A few days after the start of therapy, his hemoglobin levels and other hematological parameters rapidly improved, and a clinical improvement was observed within few weeks. Conclusion: In this case infant was suspected of vitamin B12 deficiency with anemia, hyperpigmentation of fingers and toes and history of mother being pure vegan. This underlines the importance of adequately controlling maternal vitamin B12 intake during pregnancy by means of supplementation which, in the case of vegan mothers, should be significantly greater than that usually given. Moreover, the supplementation should be continued during lactation in order to avoid the development of signs of deficiency that may be associated with persistent neurological problems in infants.