Role of Cyanocobalamin Levels in Managing Paraneoplastic Ery
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Researchers explored the different causes of the disease in adults in their excellent analysis of erythroderma. In 1 %, the aetiology is neoplastic or paraneoplastic, and within this community, erythroderma is most commonly associated with haematological malignancies and cutaneous T-cell lymphomas, which account for 25 -40 % of cancer-related cases of erythroderma.

It would be interesting for the protocol to include simple and accessible biomarkers that could assist in screening for tumors associated with erythroderma. Increased levels of cyanocobalamin (vitamin B12) are correlated with an increased risk of occult solid and hematologic malignancies.

Pathophysiology is based on the metabolism of cobalamin: under normal conditions, most cobalamin in blood (80%) does not circulate freely and must bind to transport proteins, namely, haptocorrin or type I transcobalamin, both of which can be synthesized by granulocytes. In addition, the levels of these transport proteins in blood are correlated with serum cobalamin levels, thus explaining the high levels detected in blood dyscrasia.

Nevertheless, high cobalamin levels have also been observed in some solid tumors (e.g., pharynx, esophagus, liver, stomach, biliary tract, pancreas, lung, colon-rectum, prostate, ovary, cervix, and bladder), possibly because the synthesis of type I transcobalamin could be increased by neoplastic cells themselves. On the other hand, since haptocorrin and type I transcobalamin are metabolized in the liver, primary tumors affecting the liver metastases, or other non–tumor-related causes would make it possible to detect high serum cobalamin levels owing to the reduced clearance of the binding proteins.

Researchers conclude that, while high cobalamin could be associated with smoking, alcohol, or liver disease, levels above 800?pmol/L are significantly associated with neoplasms, especially hematologic malignancies, such as non-Hodgkin lymphoma, Hodgkin lymphoma, multiple myeloma, and leukemia.

In conclusion, the inclusion of serum cobalamin levels in the erythroderma protocol would be interesting, because such a determination is simple, inexpensive and accessible for paraneoplastic erythroderma screening, in particular those associated with hematologic malignancy.