Review Question - QID 107166

A young child with poor nutrition with gum hypertrophy, corkscrew hairs, and normocytic anemia is most likely suffering from Vitamin C deficiency.

Scurvy, or vitamin C deficiency, typically occurs in those who are elderly or very young due to limited access for fresh fruits and vegetables. Consumption of these foods with denatured vitamins (due to over-boiling) can result in deficiency as well. Vitamin C deficiency can also present with normocytic, normochromic anemia because of concurrent iron and folate deficiencies.

Mandl et al. describe vitamin C's role as a cofactor in many reactions in the body. Vitamin C plays a crucial role in various hydroxylation reactions and is also required for the hydroxylation of carnitine, which is believed to be responsible for the early symptoms of scurvy. It's deficiency can result in symptoms such as swollen gums, bruising, perifollicular hemorrhage, and poor wound healing.

Yewale et al. report on the the treatment of iron deficiency anemia with ferrous ascorbate (vitamin C and iron complexed together) or ferrous colloid (iron alone). They found that both the increase in hemoglobin (P<0.01) and the proportion of non-anemic children (P<0.01) were higher in the group treated with iron ascorbate. Mechanistically, these findings result from Vitamin C's ability to chemically reduce iron and enhance its incorporation into hemoglobin.

Incorrect Answers:
Answer 1: Vitamin K deficiency would typically present with prolonged PT and aPTT with normal bleeding time.
Answer 3: Vitamin B12 deficiency would typically present with macrocytic anemia, with physical exam signs such as numbness, paresthesias of the extremities, and ataxia.
Answer 4: Iron deficiency anemia would present as microcytic anemia without changes in PT or aPTT.
Answer 5: Vitamin B3, or niacin, can present with glossitis, but would typically also have the "3 D's": diarrhea, dermatitis, and dementia.