Relationship between Vitamin B9 (Folic Acid), Vitamin B12 (Cobalamin), and Peripheral Neuropathy in Children with Beta-Thalassemia Major

Uni Gamayani, Titin Junaidi, Nushrotul Lailiyya, Nur Suryawan, Nanan Sekarwana

Abstract


Vitamin B9 (folic acid) and B12 (cobalamin) are essential vitamins that play roles in the process of hematopoiesis and maintaining the function of peripheral nerves. Therefore, these deficiencies may create a risk for peripheral neuropathy in beta-thalassemia major patients. The purpose of this study is to determine the relationship between vitamin B9 level, vitamin B12 level, and peripheral neuropathy in beta-thalassemia major children. It was an observational analytical study with a case-control design has been conducted at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in May–July 2019. There were 47 beta-thalassemia major children with peripheral neuropathy (case) and 41 healthy children (control). All subjects completed a general demographic questionnaire, underwent neurological examination, and were tested for vitamin B9 and B12 serum levels. Data were then analyzed using the unpaired t test to compare the vitamin levels between both groups and Spearman’s rank correlation test to investigate the correlation between vitamin levels and the number of affected nerves in the case group. Comparison of folic acid levels in the case group (21.52±6.22 ng/mL) and the control group (23.81±7.51 ng/mL) showed no significant difference (p=0.19). In contrast, cobalamin in the case group (288.57±168.61 ng/mL) and the control group (385.95±197.48 ng/mL) showed a significant difference (p=0.01). In addition, there was a moderate correlation (p=0.004, r=0.41) between folic acid level and the number of motoric nerves affected in the case group. In conclusion, cobalamin level correlates with peripheral neuropathy in beta-thalassemia major patients, and folic acid level correlates with the number of affected nerves, especially motoric nerves.

 

HUBUNGAN ANTARA VITAMIN B9 (ASAM FOLAT), VITAMIN B12 (KOBALAMIN), DAN NEUROPATI PERIFER PADA ANAK DENGAN TALASEMIA BETA MAYOR

Vitamin B9 (asam folat) dan B12 (kobalamin) merupakan vitamin esensial yang berperan dalam proses hematopoesis dan menjaga fungsi saraf tepi. Defisiensi vitamin ini dapat menimbulkan risiko neuropati perifer pada pasien talasemia beta mayor. Tujuan penelitian ini mengetahui hubungan antara kadar vitamin B9, vitamin B12, dan neuropati perifer pada anak talasemia beta mayor. Metode penelitian ini adalah analitik observasional dengan rancangan studi kasus kontrol yang dilakukan di RSUP Dr. Hasan Sadikin Bandung, Indonesia pada Mei–Juli 2019. Terdapat 47 anak talasemia beta mayor dengan neuropati perifer (kelompok kasus) dan 41 anak sehat (kelompok kontrol). Seluruh subjek penelitian mengisi kuesioner demografi umum, menjalani pemeriksaan fisis neurologis, serta dilakukan tes kadar vitamin B9 dan B12 serum. Uji t test tidak berpasangan digunakan untuk membandingkan kadar vitamin pada kedua kelompok dan uji korelasi Spearman untuk membandingkan kadar kedua vitamin tersebut dengan jumlah saraf yang terkena pada kelompok kasus. Perbandingan kadar asam folat kelompok kasus (21,52±6,22 ng/mL) dengan kelompok kontrol (23,81±7,51 ng/mL) menunjukkan perbedaan yang tidak bermakna (p=0,19), sedangkan perbandingan kadar kobalamin kelompok kasus (288,57±168,61 ng/mL) dengan kelompok kontrol (385,95±197,48 ng/mL) menunjukkan perbedaan yang bermakna (p=0,01). Selain itu, terdapat korelasi sedang (p=0,004; r=0,41) antara kadar asam folat dan jumlah saraf motorik yang terkena pada kelompok kasus. Kesimpulan, kadar kobalamin berhubungan dengan neuropati perifer pada penderita talasemia beta mayor dan kadar asam folat berhubungan dengan jumlah saraf yang terkena, terutama saraf motorik.


Keywords


Cobalamin; folat; folate; kobalamin; neuropati perifer; peripheral neuropathy; talasemia; thalassemia

Full Text:

PDF

References


Scellack G, Harirari P, Schellack N. B-complex vitamin deficiency and supplementation. S Afr Pharm J. 2015;82(4):28–33.

Hammond N, Wang Y, Dimachkie MM, Barohn RJ. Nutritional neuropaties. Neurol Clin. 2013;31(2):477–89.

Higgs DR, Engel JD, Stamatoyannopoulos G. Thalassaemia. Lancet. 2012;379(9813):373–83.

RSUP Dr. Hasan Sadikin. WHO: 6–10% masyarakat Indonesia memiliki keturunan thalassemia [Internet]. Bandung: RSUP Dr. Hasan Sadikin; 2014 April 22 [cited 2021 May 6]. Available from: https://web.rshs.or.id/who-6-10-masyarakat-indonesia-memiliki-keturunan-thalassemia.

Panigoro R, Rakhmila LE, Sribudiani Y, Maskoen AM, Tjandraprawira KD. Thalassemia in Indonesia: screening program, diagnosis and research. Hemoglobin. 2019;43(6):305.

Bayhan T, Ünal Ş, Konuşkan B, Erdem O, Karabulut E, Gümrük F. Assessment of peripheral neuropathy in patients with β-thalassemia via electrophysiological study: reevaluation in the era of iron chelators. Hemoglobin. 2018;42(2):113–6.

Shah FH, Idrees J, Ali Shah ST, Khan R, Khan AT, Salman S, et al. Neurological deficits among beta-thalassemia patients and its possible therapeutic intervention: a comprehensive review. J Dow Univ Health Sci. 2020;14(2):83–90.

Oliveros O, Trachtenberg F, Haines D, Gerstenberger E, Martin M, Carson S, et al. Pain over time and its effects on life in thalassemia. Am J Hematol. 2013;88(11):939–43.

Dewi WKK, Gamayani U, Lailiyya N, Reniati L, Sekarwana N. Hubungan kadar hemoglobin dan feritin serum dengan gambaran konduksi saraf pada anak talasemia beta mayor. Neurona. 2017;35(1):52–8.

Gamayani U, Putri FA, Lailiyya N, Fianza PI, Panigoro R. Neuropati perifer pada penyandang talasemia di Poliklinik Hemato-Onkologi RSUP Dr. Hasan Sadikin Bandung. Neurona. 2019;36(3):195–201.

Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5:11.

Porter J, Viprakasit V, Kattamis A. Iron overload and chelation. In: Cappellini MD, Cohen A, Porter J, Taher A, Viprakasit V, editors. Guidelines for the management of transfusion dependent thalassaemia (TDT). 3rd Edition. Nicosia: Thalassemia International Federation; 2014. p. 42–96.

Levi S, Taveggia C. Iron homeostasis in peripheral nervous system, still a black box? Antioxid Redox Signal. 2014;21(4):634–48.

Mishra AK, Tiwari A. Iron overload in beta thalassaemia major and intermedia patients. Maedica (Bucur). 2013;8(4):328–32.

Heidari M, Gerami SH, Bassett B, Graham RM, Chua AC, Aryal R, et al. Pathological relationships involving iron and myelin may constitute a shared mechanism linking various rare and common brain diseases. Rare Dis. 2016;4(1):e1198458.

Bhattacharyya S, Samuels MA. Toxic and metabolic disorders. In: Samuels MA, Ropper AH. Samuel’s manual of neurologic therapeutics. 9th Edition. Philadelphia: Wolters Kluwer; 2017. p. 584–633.

Patil VW, Mujawar SA. Deficiency of folic acid, vitamin B12 and their correlation with ferritin in childhood β-thalassemia major. Curr Pediatr Res. 2010;14(2):111–4.

Asma S, Gereglioglu C, Erdogan AF, Yeral M, Kasar M, Boga C, et al. Prevalence of iron, folic acid and vitamin B12 deficiency in patients with thalassemia minor. Turk J Fam Med Prim Care. 2013;7(4):83–6.

National Center for Biotechnology Information, U.S. National Library of Medicine. Compound summary: folic acid [Internet]. Bethesda: U.S. National Library of Medicine; 2019 January 15 [cited 2021 May 6]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/135398658.

Kang WB, Chen YJ, Lu DY, Yan JZ. Folic acid contributes to peripheral nerve injury repair by promoting Schwann cell proliferation, migration, and secretion of nerve growth factor. Neural Regen Res. 2019;14(1):132–9.

Kim GB, Chen Y, Kang W, Guo J, Payne R, Li H, et al. The critical chemical and mechanical regulation of folic acid on neural engineering. Biomaterials. 2018;178:504–16.

Fallon M, Tadi P. Histology, Schwann cells [Internet]. Treasure Island: Statpearls Publishing; 2021 May 10 [cited 2021 June 10]. Available from: https://www.statpearls.com/ArticleLibrary/viewarticle/28765.

Mahmood L. The metabolic processes of folic acid and vitamin B12 deficiency. J Health Res Rev. 2014;1(1):5–9.




DOI: https://doi.org/10.29313/gmhc.v9i2.8106

pISSN 2301-9123 | eISSN 2460-5441


Visitor since 19 October 2016: 

View My Stats


Free counters!


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