Optimization of folic acid, vitamin B12, and vitamin B6 supplements in pediatric patients with sickle cell disease
✍ Scribed by Fey P.L. van der Dijs; M. Rebecca Fokkema; D.A. Janneke Dijck-Brouwer; Bram Niessink; Thaliet I.C. van der Wal; John-John B. Schnog; Ashley J. Duits; Fred D. Muskiet; Frits A.J. Muskiet
- Publisher
- John Wiley and Sons
- Year
- 2002
- Tongue
- English
- Weight
- 112 KB
- Volume
- 69
- Category
- Article
- ISSN
- 0361-8609
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✦ Synopsis
Using homocysteine as a functional marker, we determined optimal folic acid, vitamin B 12 , and vitamin B 6 dosages in 21 pediatric sickle cell disease (SCD) patients (11 HbSS, 10 HbSC;(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Daily supplements of folic acid (400, 700, or 1,000 lg), vitamin B 12 (1, 3, or 5 U.S. 1989 RDA), and vitamin B 6 (1 or 3 U.S. 1989 RDA) were gradually increased in an 82-week dose-escalation study. Blood was taken at 9 occasions for measurements of erythrocyte (RBC) and serum folate, plasma vitamin B 12 , whole-blood vitamin B 6 , and plasma homocysteine. Augmentation of folic acid from 700 to 1,000 lg and vitamin B 12 from 3 to 5 RDA did not further decrease homocysteine. Percentages of patients exhibiting significant individual homocysteine decreases amounted to 43% (folic acid from 0 to 400 lg, vitamins B 12 and B 6 from 0 to 1 RDA), 14% (folic acid from 400 to 700 lg), 24% (vitamin B 12 from 1 to 3 RDA), and 18% (vitamin B 6 from 1 to 3 RDA ). The lowest plasma homocysteine at 82 weeks was 5.9 ± 2.2 lmol/L. Patients with HbSS had higher RBC folate than HbSC. The entire group exhibited an inverse relation between RBC folate and hemoglobin. We conclude that RBC folate is less valuable for folate status assessment in SCD patients. Optimal dosages are as follows: 700 lg folic acid (3.5-7 U.S. 1989 RDA), 3