American Journal of Clinical Nutrition, Vol 27, 51-54, Copyright © 1974 by The American Society for Clinical Nutrition, Inc.

The importance of red cell B₁₂ and folate levels after partial gastrectomy

¹ From the Hematology Section, Department of Medicine, and the Department of Laboratory Medicine, Veterans Administration Hospital, Minneapolis, Minnesota 55417, and the University of Minnesota, Minneapolis, Minnesota 55455

In 107 partially gastrectomized patients, B_{1 2} and folate concentrations were measured in serum and red cells. Diminished B₁₂ levels were found much more frequently in red cells than in serum (68 versus 37%). In patients with low serum B₁₂, coexistent iron deficiency was associated with more pronounced depletion of RBC B₁₂, the mean RBC:serum B₁₂ ratio being 0.55 and 1.15 in iron-deficient and normoferremic groups, respectively. Fourteen partially gastrectomized patients had low RBC B₁₂ levels as the sole biochemical criterion of B₁₂ deficiency; five of these patients were anemic, five had macrocytosis, and all 14 had neutrophil hypersegmentation. Abnormally low serum and red cell folate levels were detected in 33 and 17% of the 107 patients, respectively. Iron deficiency was accompanied by increased RBC folate concentrations (mean 467 ng/ml versus 306 ng/ml in the normoferremic group). The results indicate that l) in gastrectomized patients, decreased RBC B₁₂ concentration is the most sensitive index of B₁₂ deficiency; 2) iron deficiency appears to accentuate RBC B₁₂ depletion and to increase red cell folate levels.