Vitamin B12 Deficiency as a Silent Contributor to Hematological Alterations in Pediatric Anemia: A Descriptive Analysis in Al Diwaniyah province

Author(s): Ayaat Abbas Abdulsada
Date: 09/10/2026
doi: https://doi.org/10.5281/zenodo.8425890

Abstract

In  Al-Diwaniyah governorate ,where microcytic anemia widely affects  children , vitamin B12 deficiency 
frequently acts as a  "silent contributor" to pediatric hematological disorders as concurrent iron deficiency 
often  masks its presence due to the systematic unavailability of routine serum B12 assays in public 
healthcare settings clinicians must rely heavily  on complete blood count (CBC) parameters this study 
evaluates 60 pediatric cases to bridge this diagnostic gap. Our statistical analysis reveals a critical 
diagnostic discordance :42% of the patient population exhibited an elevated Red Cell Distribution width 
(RDW > 15.0%) despite retaining microcytic Mean Corpuscular Volume (MCV) indices (p<0.05). This 
pivotal outcome serves as the cornerstone of our research, proving that RDW acts as a reliable 
morphological sentinel  to uncover hidden B12 deficiency when  traditional MCV based screening fails, 
validating RDW as robust cost effective surrogate index proving  a strategic diagnostic solution for 
resource constrained areas by enabling early identification of occult nutritional imbalances these finding 
offer a practical approach to prevent the development of treatment refractory anemia in local  pediatric 
cohorts. This study aims to delineate the hematological signatures of latent vitamin B12 deficiency 
through a comprehensive analysis of erythrocyte indices  (RDW , MCV, MCHC) of 90 patient ,The 
primary goal is to identify diagnostic patterns that signal early B12 –associated dyserythropoiesis 
,particularly in cases where classical macrocytosis is absent , thereby bridging  the diagnostic gap in occult 
nutritional deficiencies. RDW is reliable indicator of the "silent signature " of B12 deficiency, which 
warrants consideration when conventional iron therapy fails.

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