Subklinik B12 Vitamin Eksikliği Saptanan Hastalarda Nötrofil Segment ve Lob Sayıları
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Neutrophil segment and lobe count in patients with subclinical vitamin B12 deficiency. Hacettepe University Faculty of Medicine Department of İnternal Medicine, Specialization Thesis, Ankara, 2018. Introduction and Purpose: Vitamin B12 is a water-soluble vitamin and it can not be made in human body. Its main function is to act as a coenzyme and cofactor in DNA synthesis together with folic acid. It is especially necessary for the maintenance of normal hematopoiesis and continuity of the nervous system. Some hematological, gastrointestinal and neurological disorders occur in case of vitamin B12 deficiency. The aim of this study was to determine the number of segmentation and lobation numbers in neutrophil nuclei and to evaluate the contribution of these parameters to the diagnosis of vitamin B12 deficiency. Patients and Methods: This is a descriptive prospective study conducted at the Hacettepe University Hematology Outpatient Clinic between April 2018 and September 2018. Forty-five patients with vitamin B12 deficiency and 50 healthy volunteers were evaluated. The demographic data of the patients were obtained from the hospital electronic system. The lobes and segments were counted in 20 neutrophils in each peripheral smear. A segment was considered when both lobes were separated by a fine chromatin network. Lobes were defined as core regions separated by at least 2/3 knotted chromatin. Results: 52% of the patients were female and 48% were male; 68% of the control group were female and 32% were male. Patients with apparent B12 deficiency had the highest lobation rate (mean ± standard deviation = 3,44 ± 0,8). Mean lobation rate was decreasing in the order of manifest B12 deficiency, subclinical deficiency and control group. However such a trend was not present for segment count. A lobe count higher than 4 had the most appropriate sensitivity (75%) and specificity (94%) in detecting B12 deficiency. Using higher than 4 segments as a treshold showed low sensitivity (%20). Nowadays, in patients with deficiency due to frequent screening of vitamin B12 levels and easy access of laboratory tests, increased lobulation increase in peripheral smear without hypersegmentation was found to be valuable in detecting B12 deficiency.It is thought that in patients with low vitamin B12 levels, the increase in lobulation in the neutrophil cell nucleus without homocysteine or without anemia and macrocytosis is thought to be helpful.