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Scurvy, an old story in a new time: The hematologist's experience
Roy Khalife1, Anthony Grieco1, Karima Khamisa1
1Division of Hematology, University of Ottawa, Canada.
Insights
Scurvy diagnosis can be delayed in developed countries. Early recognition of risk factors and individualized treatment, including vitamin C supplementation, are crucial for managing this rare condition.
Area of Science:
- Hematology
- Nutritional Deficiencies
Background:
- Scurvy is uncommon in developed nations, often leading to diagnostic delays and complications.
- An observed rise in scurvy cases prompted a literature review for improved diagnosis and management.
Purpose of the Study:
- To review the diagnosis and optimal management of scurvy patients.
- To identify common comorbidities and clinical presentations in scurvy.
Main Methods:
- Retrospective chart review of 22 adult patients diagnosed with scurvy between 2010 and 2018.
- Data included patient characteristics, clinical features, bloodwork, and treatment response.
Main Results:
- Mean vitamin C level was 6 μmol/L. Common comorbidities included iron deficiency anemia and gastrointestinal disorders (54% each).
- Bleeding and bruising (45% each) were frequent symptoms. Treatment varied, with oral and intravenous vitamin C supplementation used.
Conclusions:
- Increased awareness of scurvy's risk factors and presentation is vital for patients with bleeding tendencies.
- Individualized treatment plans, considering diet, medical history, and medications, are essential for effective scurvy management.
Background:
Scurvy is a rare entity in developed countries and the diagnosis may often be delayed resulting in unnecessary investigations and/or potentially severe complications. A recent increase in the number of patients diagnosed with scurvy in our hematology clinics indicated the need to review the literature on the diagnosis and optimal management of similar patients.
Methods:
We conducted a retrospective chart review of patients referred to hematology at our tertiary care centre between 2010 and 2018, who were ultimately diagnosed with scurvy. Data collected from electronic medical records included baseline characteristics, clinical features on presentation, bloodwork results from initial consultation, treatment plan as well as response to treatment.
Findings:
Twenty-two adults patient had a diagnosis of scurvy with a mean vitamin C level of 6 μmol/L. Iron deficiency anemia (54%) and gastrointestinal disorders (54%) were the most common comorbidities noted in our cohort. Proton-pump inhibitors use was noted in 54% of patients. Bleeding (45%) and bruising (45%) were the most commonly reported clinical features. Eleven patients received oral supplementation, five had intravenous (IV) vitamin C and six were not treated. Two patients required a transition from oral to IV supplementation. Vitamin C dosing ranged between 250 and 2000 mg and the frequency varied from daily for oral therapy to every few weeks or months for IV.
Interpretation:
Awareness of scurvy and its associated risk factors and clinical presentation is important in the evaluation of a patient with bleeding tendency. Treatment plan should be individualized, and a careful review of patients' diet, medial history and medications is warranted.