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Abstract: SA-PO1033

Hypersegmented Neutrophils in Hemodialysis Patients and Cobalamin (B12) Requirements

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Vakiani, Styliani, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
  • Bozikas, Andreas, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
  • Dimitrakopoulos, Konstantinos, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
  • Pozoukidou, Kalliopi, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
  • Kitoukidi, Eleni, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
  • Martika, Antigoni, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
  • Koteli, Asimoula, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
  • Spaia, Sofia, General Hospital of Thessaloniki "Agios Pavlos", Thessaloniki, Greece
Background

Estimation of Nuclear Hypersegmentation of Neutrophils (HN) has been widely used as an indicator of Vitamin B12 (B12) or Folate (FO) deficiency. We chose to monitor the above as an indicator of functional deficiency of B12, since B12 supplementation, either for reducing the level of homocysteine (HC) or as factor decreasing erythropoietin (EPO) resistance in hemodialysis (HD) patients (pts), still remains a controversial issue.

Methods

Serum B12 levels were calculated from 57 HD pts prior to HD, after having received weekly intramuscular B12 injections (1000 μg Cyanocobalamine) for the past 6 months. All pts had smears of their peripheral blood examined to assess percentage of cells with HN, finding consistent with B12 deficiency. Hgb, MCV, FO, HC, PTH levels, Kt/V and EPO requirements were also recorded. Testing was repeated 6 months after discontinuation of B12 supplementation and 6 months after re-challenging with B12. FO supplements were administered throughout the study. Ferritin levels were kept > 200 ng/mL.

Results

Nuclear Hypersegmentation of Neutrophils was found in 55% of our patients to exceed the accepted level of 5% and reached 100% after stopping B12 supplementation along with a significant increase in EPO requirements, though B12 levels were well above the upper normal limit. EPO needs returned to previous levels after re-challenge with B12. HC and FO levels were unaffected. No difference in other parameters were observed.

Conclusion

In this study maintaining FO levels stable, we have demonstrated that despite high B12 blood levels, there is a functional deficiency which is reversed by B12 supplementation. HN seems to be a sensitive indicator of this process. The elevated percentage of HN in these pts (55%) has not been elucidated in the literature. When B12 was discontinued, 100% of the neutrophils nuclei were rendered hypersegmented but responded to B12, 6 months later, lowering overall EPO requirements. In spite of this beneficial effect, the optimal frequency and supplemental dose remain to be clarified.

Results
 HN %B12 pg/mLFO ng/mLHC μm/LEPO U/Hgb/L
T055*4275.6*19.8720.1403.05*
T6100*821*19.0520.08531.13*
T1263*3407.5*20.0318.92407.95
p< 0.05< 0.05nsns< 0.05