A Study of Neutrophil Hyper segmentation in the Elderly and its Diagnostic Value for Cobalamin and Folic Acid Deficiency in Mashhad, Iran.

The prevalence of cobalamin and folic acid is high in the elderly. Ambiguous clinical findings, different laboratory methods and normal range, and expensiveness of laboratory tests have been resulted in complexity and delay in diagnosis of deficiency. The aim of this study is to evaluate the relation between hematologic parameters especially neutrophil hypersegmentation and cobalamin andfolic acid insufficiency as well as increased serum hemocystein. Methods and materials: Three hundred subjects above 65 years old in twelve regions of Mashhad were studied. This population was selected by the Provincial Health Center. 250 subjects were analyzed for serum cobalamin and folate by RIA method. 78 subjects, who had cobalamin 120-450 pg/ml and folate 1.5-17ng/ml without any confounders, were analyzed for homocystein (Hcy) by Elisa method. Hematological parameters were assayed by H1 system and blood smear by microscopic observation. Data were analyzed by SPSS 11.5 software. p<0/05 was considered as significant. Among 235participants, 45.5% were positive for neutrophil hypersegmentation (NH) and %54.5 were negative. There wasn’t significant correlation between NH and gender. In 216 subjects, 56.7% had red blood cell macrocytosis. There was a significant relation between severity of NH and macrocytosis (p=0.001). Macrocytosis had significant correlation with folate deficiency (p=0.017). NH showed a significant relation with folate (p=0.036) but no correlation with cobalamin With respect to the high incidence of folate deficiency in the elderly, a simple and economic screening test such as NH and macrocytosis could be used for evaluation of serum folate. Although the specificity and sensitivity of NH for diagnosis of folate deficiency is not high it can be used as a screening test.