Official publication of Rawalpindi Medical University
The frequency of vitamin B12 derangements in females presenting for workup of iron deficiency anemia

Supplementary Files


How to Cite

Atzaz N, Khattak M, Zuhra FT, Afzal J, Khaliq S, Saeed S. The frequency of vitamin B12 derangements in females presenting for workup of iron deficiency anemia. JRMC [Internet]. 2023 Jun. 24 [cited 2024 Jun. 25];27(2). Available from:


Objective: Iron deficiency anemia (IDA) is the most prevalent hematological disorder in women of child-bearing age. IDA poses a threat to feto-maternal wellbeing. It is the leading cause of morbidity and mortality in pregnancy. IDA in young females can coexist with other nutritional deficiencies such as vitamin B12 (Vit B12). An undetected Vit B12 deficiency carries a greater likelihood of development of maternal neuropsychiatric disorders and neural tube defects in the fetus.

Materials and methods: Venous blood samples of non-pregnant female population (N=133) from Fauji Foundation Hospital, Rawalpindi were collected and analyzed for complete blood count (CBC), Vit B12 and serum Ferritin. Population was further subdivided into two groups. Group A, included females with low serum Ferritin and low MCV, group B restricted to normal serum Ferritin and low MCV, whereas control group had females with normal serum Ferritin and MCV levels.

Results: Demographic data suggested that only height was slightly lower in IDA patients other than reduced serum Ferritin levels. Group A also showed reduced levels of Vit B12 as compared to group B and control group. CBC analysis indicated marked reduction in all hematological parameters except platelet count in group A.

Conclusion: Our findings suggest that IDA and Vit B12 deficiency may coexist in young females. Monitoring Vit B12 along with iron deficiency parameters is essential to treat anemia and prevent gynecological complications. Paucity of information on their coexistence in females of childbearing age require further investigation.

Keywords: Vitamin B12, Iron deficiency anemia, Microcytosis, Serum Ferritin.


Clark SF. Iron deficiency anaemia. Nutrition in clinical practice. 2008;23(2):128-41. doi: 10.1177/0884533608314536.

Mansvelt E. Iron Deficiency (ID) and Iron Deficiency Anaemia (IDA): clinical. Professional Nursing Today. 2009;13(1):29-30.

Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron Deficiency Anemia in Pregnancy. Women's Health. 2015;11(6):891-900.

Pavlova T, Petrukhin V, Zhiliaeva O, Nadezhdin S. Placental morphology in pregnancy complicated with iron-deficiency anemia. Arkhiv Patologii. 2007;69(2):31-2.

Reveiz L, Gyte GM, Cuervo LG, Casasbuenas A. Treatments for iron‐deficiency anaemia in pregnancy. Cochrane Database of Systematic Reviews. 2011(10). doi: 10.1002/14651858.CD003094.

McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009;12(4):444-54. doi: 10.1017/s1368980008002401.

Organization WH. Global anaemia prevalence and number of individuals affected. Reference Source. 2015.

Daru J, Allotey J, Peña‐Rosas J, Khan K. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfusion Medicine. 2017;27(3):167-74. doi: 10.1111/tme.12408.

Hennek JW, Kumar AA, Wiltschko AB, Patton MR, Lee SYR, Brugnara C, et al. Diagnosis of iron deficiency anemia using density-based fractionation of red blood cells. Lab on a Chip. 2016;16(20):3929-39. doi: 10.1039/C6LC00875E.

Farrukh GM, Hasan Z, Ikram S, Tariq B. Iron deficiency anemia: dietary pattern of iron intake from indigenous iron rich food in female ida patients and corresponding hematological profiles: a cross sectional study at a tertiary care hospital in karachi. The Professional Medical Journal. 2016;23(09):1092-8. doi: 10.17957/TPMJ/16.3520.

Organization WH. Standards for maternal and neonatal care. 2007.

Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose. Drugs. 2009;69(6):739-56. doi: 10.2165/00003495-200969060-00007.

Stabler SP. Vitamin B12 deficiency. New England Journal of Medicine. 2013;368(2):149-60.

Oh RC, Brown DL. Vitamin B12 deficiency. American family physician. 2003;67(5):979-86.

Green R, Allen LH, Bjørke-Monsen A-L, Brito A, Guéant J-L, Miller JW, et al. Vitamin B12 deficiency. Nature reviews Disease primers. 2017;3(1):1-20. doi:

Trumbo P, Yates AA, Schlicker S, Poos M. Dietary reference intakes. Journal of the American Dietetic Association. 2001;101(3):294-.doi: 10.1016/s0002-8223(01)00078-5

Arslan SA, Arslan I, Tirnaksiz F. Cobalamins and methylcobalamin: coenzyme of vitamin B12. FABAD Journal of Pharmaceutical Sciences. 2013;38(3):151.

Sirdah MM, Yassin MM, Shekhi SE, Lubbad AM. Homocysteine and vitamin B 12 status and iron deficiency anemia in female university students from Gaza Strip, Palestine. Revista brasileira de hematologia e hemoterapia. 2014;36:208-12. doi: 10.1016/j.bjhh.2014.03.005.

Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ open gastroenterology. 2022;9(1):e000759. doi: 10.1136/bmjgast-2021-000759.

Cacoub P, Choukroun G, Cohen‐Solal A, Luporsi E, Peyrin‐Biroulet L, Peoc'h K, et al. Iron deficiency screening is a key issue in chronic inflammatory diseases: A call for actions. Journal of Internal Medicine. 2022. doi: 10.1111/joim.13503.

Zoirovich AZ. Causes and symptoms of anemia in pregnant women. Eurasian Medical Research Periodical. 2022;7:218-20.

Torrez M, Chabot‐Richards D, Babu D, Lockhart E, Foucar K. How I investigate acquired megaloblastic anemia. International Journal of Laboratory Hematology. 2022. doi: org/10.1111/ijlh.13789.

Qadir MA, Rashid N, Mengal MA, Hasni MS, Khan GM, Shawani NA, et al. Iron-Deficiency Anemia in Women of Reproductive Age in Urban Areas of Quetta District, Pakistan. BioMed Research International. 2022;2022. doi: 10.1155/2022/6677249.

Mohammed SG, Mousa A, Hamead M, Hashim AM. Role of Hypochromia and Microcytosis in theprediction of iron deficiency anemia. Minia Journal of Medical Research. 2022:262-8. doi: 10.21608/mjmr.2022.220289.

Drobniewski M, Borowski A, Krasińska M, Sibiński M, Synder M. Return to Work after Surgical Treatment of Coxarthrosis by Total Cementless Hip Arthroplasty. Ortopedia, traumatologia, rehabilitacja. 2017;19(4):349-60. doi: 10.5604/01.3001.0010.4644.

Chai A, Huang O, Rakocevic R, Chung P. Critical Iron Deficiency Anemia with Record Low Hemoglobin. C45 hematology and oncology cases: American Thoracic Society; 2022. p. A4235-A. doi: 10.1186/s13256-021-03024-9.

Figueroa-Mujica R, Ccahuantico LA, Ccorahua-Rios MS, Sanchez-Huaman JJ, Vásquez-Velasquez C, Ponce-Huarancca JM, et al. A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status. Life. 2022;12(5):727. doi: 10.3390/life12050727.

Bilic E, Bilic E, Zagar M, Juric S. Masked deficit of vitamin B12 in the patient with heterozygous b-thalassemia and spastic paraparesis. Acta neurol belg. 2004;104:173-5.

Busaleh F, Alasmakh OA, Almohammedsaleh F, Almutairi MF, Al Najjar JS, Alabdulatif A. Microcytic Anemia Hiding Vitamin B12 Deficiency Anemia. Cureus. 2021;13(12). doi: 10.7759/cureus.20741.

Fatima SH, Ahmad T, Latha S, Javed G, Minhajuddin A. A study of anemia profile in a research hospital in Telangana, South India. International Journal of Advances in Medicine. 2022;9(3):273. doi: 10.18203/2349-3933.ijam20220430.

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyright (c) 2023 Noreen Atzaz