Profiling vitamin B12 deficiency as an under-recognized significant cause of chronic anemia in Rwanda: The need to re-visit and describe our disease ecology

Background: Chronic anemia poses a significant burden to our emergency room (ER) where affected patients present with low hemoglobin levels requiring immediate blood transfusion. The evaluation of the cause for anemia has been variably undertaken by the receiving physicians. This report aims at providing a preliminary description of the ecology of this disease entity at a tertiary referral hospital in Rwanda. Methods: Description of complete blood count (CBC) and the status of serum vitamin B12 among randomly selected patients with chronic anemia seen at our Outpatient Clinic (OPD). The effect of empirical supplementation with vitamin B12 is measured by serial CBCs and reticulocyte response in a small series of patients requiring urgent blood transfusion in the ER. Simple descriptive statistics are used to report the findings. Results: A total of 87 patients are reported in this review. Serum vitamin B12 deficiency was found in 30/87 (34%) subjects with anemia. The affected patients were having significant macrocytosis and reticulocytopenia. The supplementation with vitamin B12 was safe and yielded significant reticulocyte response. We observed a progressive trend up in hemoglobin levels and reversal of the anemia in more than half of the patients when tested in a one-month follow-up. The patients with splenomegaly (thought to be related to malaria) tend to respond less to the supplementation with vitamin B12. Conclusion: Vitamin B12 deficiency is common among patients with chronic anemia in Rwanda. Empirical supplementation with this vitamin is an attractive and safe option in a clinical setting with a limited laboratory testing capacity.