Atul Mohankar, Jyoti Prakash Swain, Shrikant Verma
BACKGROUND B12 deficiency is common in India as is Vitamin D, folic acid, or iron deficiency. Megaloblastic Anaemia due to vitamin B12 deficiency is extremely common in the predominantly vegetarian population. The symptoms are modified also by the underlying disorder causing its deficiency. Knuckle hyperpigmentation is one of the essential features of it. In spite of being a common disorder, its recognition is delayed or missed because the manifestations are diverse in nature, and is often subclinical. Laboratory estimations of B12 levels are also not reliable. The ways of picking up those with clinical or subclinical B12 deficiency and the reasons and solutions are very much needed. Here we emphasize the clinical sign of knuckle hyper pigmentation as an important clue towards the aetiology of Megaloblastic Anaemia.
The aim of the study is to know the correlation of knuckle hyper pigmentation with serum vitamin B12 deficiency in vegetarian population.
MATERIALS AND METHODS
40 patients with knuckle hyperpigmentation, all were vegetarian screened for serum vitamin B12 deficiency.
RESULTS
Out of 40 patients, 28 females and 12 males, 32(80%) patients showed decreased levels of serum Vitamin B12.
CONCLUSION
Vitamin B12 deficiency is not uncommon in vegetarian population and knuckle hyperpigmentation is an early marker of this and need larger studies to know it better. Knuckle pad hyperpigmentation is much more frequent than diffuse pigmentation of the palms and/or soles in such patents. Few patients with vitamin B12 deficiencies do present with severe anaemia requiring blood transfusions and often have skin hyperpigmentation.
