Anaemia is the condition where there are not enough healthy red blood cells (RBC) to carry adequate oxygen to body’s tissues. It is defined by haemoglobin levels below normal values. 1,5 billion people worldwide have anaemia, with a larger prevalence among pre-school age children, pregnant women and non-pregnant women (World Health Organization data 2008).
Ferritin is an intracellular protein that stores iron and releases it where and when it is needed. Iron deficiency anaemia (IDA) is the most common nutritional disorder, responsible for 50% of anaemia cases.
IDA diminished red blood cell production due to low iron stores in the body and is characterized mostly by microcytic erythrocytes, even though it can also be present with normocytic erythrocytes. Serum ferritin is one of the main test for iron deficiency and it is the first assessment needed to elucidate the causes of anaemia.
Vitamin B12 (cobalamin) is a water-soluble vitamin that is crucial to normal neurologic function, red blood cell production and DNA synthesis. The vitamin is absorbed from the food in the small intestine as complex B12-Intrinsic Factor. Dietary deficiency, intestinal malabsorption, autoimmune disease can lead to vitamin B12 deficiency that can turn into megaloblastic anaemia. Affected patients may experience weakness, irritability, jaundice, cognitive impairment. Vitamin B12 is the initial test to perform in case of megaloblastic anaemia together with folate, in order to assess the causes of megaloblastic anaemia and establish the right treatment.
Part of the B complex of vitamins, Folate is generic term for a group of water-soluble compounds and enzymatic cofactors (B9). It is critical in the metabolism of nucleic acid precursors and several amino acids, as well as in methylation reactions and is necessary for normal red blood cell formation. Folate deficiency (together with B12 deficiency) is the main cause of megaloblastic anaemia. If serum folate is low, also Vitamin B12 has to be assessed to exclude concurrent vitamin B12 deficiency before correcting the level of folate.
Anaemia may have different causes, which need to be elucidated in order to provide the right treatment to patient. One of the major cause of anaemia is unsufficient dietary intake of some nutrients that are needed for the correct RBC formation. Iron is needed for the synthesis of haemoglobin (which binds oxygen in the RBC), while vitamin B12 and folate are two vitamins acting as ezymatic co-factors involved in the synthesis of RBCs.