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Acquired thiamine deficiency anemia — Clinical Guidelines

Overview

Acquired thiamine deficiency anemia results from inadequate thiamine (vitamin B1) intake or impaired absorption, leading to impaired cellular energy metabolism and potentially severe neurological and cardiovascular complications 1 6 12.

Diagnosis

Clinical Symptoms: Weakness, fatigue, neuropathy, cardiovascular issues (e.g., edema, arrhythmias), and cognitive disturbances 2 6 10 11.

Laboratory Tests: Elevated lactate levels, low erythrocyte transketolase activity, decreased serum thiamine levels 2 6 18.

Imaging and Neurological Assessments: Brain imaging (e.g., MRI) and neurophysiological tests to rule out Wernicke's encephalopathy or other neurological deficits 2.

Management

Thiamine Supplementation: Administer parenteral thiamine (e.g., fursultiamine) for severe deficiency; oral supplementation for milder cases 6 13.

Dietary Correction: Ensure adequate intake of thiamine-rich foods (e.g., whole grains, meat, legumes) 12.

Supportive Care: Address underlying conditions (e.g., malnutrition, alcoholism), manage complications (e.g., fluid balance, metabolic acidosis) 6 17.

Special Populations

Pediatrics: High risk in malnourished children, especially post-bariatric surgery 2.

Elderly: Increased susceptibility due to dietary restrictions and comorbid conditions 8.

Comorbidities: Patients with alcoholism, malnutrition, or those on prolonged parenteral nutrition are at higher risk 6 12 13.

Key Recommendations

Identify High-Risk Groups: Screen adolescents and young adults post-bariatric surgery and elderly patients with malnutrition for thiamine deficiency (Evidence: Moderate 2).

Early Parenteral Thiamine Therapy: Initiate parenteral thiamine supplementation promptly in suspected cases to prevent severe complications (Evidence: Moderate 6 13).

Monitor Laboratory Markers: Utilize elevated lactate levels and decreased transketolase activity as indicators for thiamine deficiency (Evidence: Moderate 2 18).

Dietary Management: Emphasize a balanced diet rich in thiamine for long-term prevention, especially in populations with restricted diets (Evidence: Expert opinion 12).

References

1 Szabó E, Pálinkás M, Bohár B, Literáti-Nagy B, Korányi L, Poór G et al.. Genetic Variants of the Human Thiamine Transporter (. International journal of molecular sciences 2025. link 2 Ibrahim T, El Ansari W, Abusabeib A, Yousaf Z, Elhag W. Infrequent but serious? Beriberi And Thiamine deficiency among adolescents and young adults after bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery 2024. link 3 Smith TJ, Arnold CD, Fischer PR, Trehan I, Hiffler L, Sitthideth D et al.. A Predictive Model for Thiamine Responsive Disorders Among Infants and Young Children: Results from a Prospective Cohort Study in Lao People's Democratic Republic. The Journal of pediatrics 2024. link 4 Ruetz M, Koutmos M, Kräutler B. Antivitamins B. Methods in enzymology 2022. link 5 Verstraete J, Stove C. Volumetric absorptive microsampling (VAMS) as a reliable tool to assess thiamine status in dried blood microsamples: a comparative study. The American journal of clinical nutrition 2021. link 6 Nakamura H, Utsunomiya A, Ishida Y, Horita T. Thiamine Deficiency in a Nondrinker and Secondary Pulmonary Edema after Thiamine Replenishment. Internal medicine (Tokyo, Japan) 2020. link 7 Harada D, Nakayama M. Influence of Glucose Dosage in Parenteral Nutrition on Body Thiamine Levels in Rats. International journal of medical sciences 2019. link 8 Tan TXZ, Lim KC, Chan Chung C, Aung T. Starvation-induced diplopia and weakness: a case of beriberi and Wernicke's encephalopathy. BMJ case reports 2019. link 9 Nilles EJ, Manaia A, Ruaia B, Huppatz C, Ward C, George P et al.. Re-emergence of thiamine deficiency disease in the Pacific islands (2014-15): A case-control study. PloS one 2018. link 10 Di Marco S, Pilati L, Brighina F, Fierro B, Cosentino G. Wernicke-Korsakoff syndrome complicated by subacute beriberi neuropathy in an alcoholic patient. Clinical neurology and neurosurgery 2018. link 11 Chisolm-Straker M, Cherkas D. Altered and unstable: wet beriberi, a clinical review. The Journal of emergency medicine 2013. link 12 Sriram K, Manzanares W, Joseph K. Thiamine in nutrition therapy. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2012. link 13 Ferrie S. Case report of acute thiamine deficiency occurring as a complication of vitamin-free parenteral nutrition. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2012. link 14 Ross JP, Honeyfield DC, Brown SB, Brown LR, Waddle AR, Welker ME et al.. Gizzard shad thiaminase activity and its effect on the thiamine status of captive American alligators Alligator mississippiensis. Journal of aquatic animal health 2009. link 15 Al-Nasser B, Callenaere C, Just A. Lower limb neuropathy after spinal anesthesia in a patient with latent thiamine deficiency. Journal of clinical anesthesia 2006. link 16 DiGesualdo CL, Hoover JP, Lorenz MD. Presumed primary thiamine deficiency in a young African lion (Panthera leo). Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians 2005. link 17 Klein M, Weksler N, Gurman GM. Fatal metabolic acidosis caused by thiamine deficiency. The Journal of emergency medicine 2004. link 18 Icke G, Nicol D. Automated microbiological assay of thiamin in serum and red cells. Journal of clinical pathology 1994. link 19 Whyte KF, Dunnigan MG, McIntosh WB. Excessive beer consumption and beri-beri. Scottish medical journal 1982. link

Acquired thiamine deficiency anemia