Overview
Vitamin C deficiency anemia, also known as scurvy, arises from insufficient intake or poor absorption of ascorbic acid (vitamin C), leading to impaired collagen synthesis, weakened connective tissues, and ultimately anemia characterized by normocytic, normochromic red blood cells. This condition is clinically significant due to its systemic effects on wound healing, immune function, and overall tissue integrity. While historically prevalent among sailors and malnourished populations, scurvy can still occur in individuals with restrictive diets, chronic malnutrition, alcoholism, and certain gastrointestinal disorders that impair nutrient absorption. Recognizing scurvy is crucial in day-to-day practice as it often presents with nonspecific symptoms that can mimic other conditions, necessitating a high index of suspicion for timely intervention 89.Pathophysiology
Vitamin C plays a pivotal role in multiple biochemical processes, particularly in the hydroxylation of proline and lysine, essential for collagen synthesis. Without adequate vitamin C, collagen molecules cannot form stable triple helices, leading to weakened connective tissues such as skin, blood vessels, and bone matrix. This structural compromise manifests clinically as easy bruising, petechiae, and poor wound healing. Additionally, vitamin C is crucial for the metabolism of iron, specifically enhancing the absorption of non-heme iron and recycling ferritin back into usable iron stores. Deficiency impairs these processes, contributing to iron-deficiency anemia despite normal iron stores, characterized by microcytic anemia in severe cases 821.Epidemiology
Scurvy is relatively rare in developed countries but remains a concern in populations with limited dietary diversity, including the elderly, individuals with chronic diseases affecting nutrition, and those with restrictive diets (e.g., vegans). Incidence rates are difficult to pinpoint due to underreporting and misdiagnosis, but prevalence is notably higher in institutionalized settings and among those with socioeconomic challenges. Geographic disparities exist, with higher reported cases in regions where fresh fruits and vegetables are scarce. Trends suggest an increase in awareness and reporting, yet true incidence remains understudied compared to other nutritional deficiencies 8911.Clinical Presentation
The clinical presentation of scurvy can be protean, ranging from subtle symptoms to severe systemic involvement. Early signs include fatigue, malaise, and generalized weakness. As deficiency progresses, patients may exhibit:Diagnosis
Diagnosing scurvy involves a combination of clinical suspicion and laboratory confirmation. Key diagnostic steps include:Management
Initial Management
Refractory Cases
Complications
Prognosis & Follow-up
The prognosis for scurvy is generally good with early diagnosis and adequate vitamin C repletion. Prognostic indicators include the rapidity of symptom resolution and normalization of laboratory parameters. Recommended follow-up intervals include:Special Populations
Key Recommendations
References
Showing 100 most recent of 1206 indexed papers.
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