THE EFFECT OF CONCOMITANT VITAMIN B12 AND FERRITIN DEFICIENCY ON CERTAIN RED BLOOD CELL PARAMETERS IN END-STAGE RENAL DISEASE PATIENTS UNDERGOING REGULAR HEMODIALYSIS

Abstract

Introduction: Identifying and treating comorbid causes of anemia in patients with end-stage renal disease (ESRD) undergoing regular dialysis plays a crucial role. However, the overlap of vitamin B12 deficiency and ferritin deficiency in this population makes the evaluation of red blood cell parameters complex. Objects: Evaluate the characteristics of parameters related to red blood cell size, blood ferritin levels, and vitamin B12 levels, as well as the correlation between these parameters. Materials and methods: A cross-sectional descriptive study with analysis was conducted on 135 patients diagnosed with end-stage renal disease undergoing regular dialysis at Bac Lieu General Hospital from May 2023 to May 2024. Results: The average age of the study subjects was 49.6 ± 14.8 years, with a male/female ratio of approximately 1/1. The anemia rate was 97.0%, with the majority being moderate anemia (60.0%). Microcytic red blood cells predominated (89.6%), and the hypochromic rate was 20.7%. The median blood ferritin level (Q1-Q3) was 499.3 (310.0-774.9) ng/mL, with a ferritin deficiency rate of 23.2%. The median blood vitamin B12 level (Q1-Q3) was 566.0 (290.0-818.0) pg/mL, with a vitamin B12 deficiency rate of 30.4%. There was a positive correlation between ferritin and MCV in the ferritin-deficient group (r=0.359, p=0.044). In the normal vitamin B12 group, red blood cells in the ferritin-deficient group were smaller (MCV: 87.27 ± 5.28 vs. 90.52 ± 6.1; p=0.017) and more hypochromic (median MCH: 27.9 vs. 29.45; p=0.003) compared to the normal ferritin group. Conversely, there was no difference in MCV and MCH in the vitamin B12 deficient group regardless of ferritin levels (p > 0.05). Conclusion: In ESRD patients undergoing regular dialysis, those with isolated ferritin deficiency had smaller, more hypochromic red blood cells compared to those without ferritin deficiency. However, if there is concurrent vitamin B12 deficiency, red blood cells may become normochromic and normocytic regardless of ferritin status.