Vitamin C deficiency in patients with acute myeloid leukemia: a case series and review of the literature
Open accessAbstract
Vitamin C (Vc) deficiency is characterized by an array of mucocutaneous findings, including ecchymoses, petechiae, perifollicular hemorrhage, oral ulcerations, gingival hypertrophy, and corkscrew hairs.In addition, it can cause cardiovascular, pulmonary, and neuropsychiatric effects and may be fatal if left untreated.1,2 Also known as ascorbic acid, Vc acts as an essential cofactor to enzymes prolyl hydroxylase and lysyl hydroxylase, which crosslink propeptides to stabilize the structure of collagen.Scurvy, the clinical disease caused by Vc deficiency, is primarily seen in patients with restrictive diets, resource limitations, substance abuse, and malabsorption syndromes.2 Currently defined as Vc concentrations <11 μmol/L, many consider hypovitaminosis C to be represented by serum concentrations of <30 μmol/L.
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Physical signs, though nonspecific, gain diagnostic value when correlated with biochemical and dietary data.
“This synthesis converges with the evidence presented by Milbar et al. [155], who noted that physical signs, though nonspecific, gain diagnostic value when correlated with biochemical and dietary data [30].”
From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [155]
In the main text (page unavailable), Milbar et al. warn that signs of vitamin C deficiency in patients with AML can be mistaken for effects of leukemia or treatment. They also describe serum vitamin C thresholds and dietary factors, but do not explicitly assess whether correlating physical signs with biochemical and dietary data improves diagnostic value. (LLM, conf=0.78)
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Cites
Ascorbate regulates haematopoietic stem cell function and leukaemogenesis
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Ascorbic acid serum levels are reduced in patients with hematological malignancies
Huijskens, M. J. A. J., Wodzig, W. K. W. H., Walczak, M., Germeraad, W. T. V., & Bos, G. M. J. (2016) · Results in Immunology · doi:10.1016/j.rinim.2016.01.001 · Cited by 106 · see citing works
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Research works printed but not linked: 20
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- [9]Foster MN Carr AC Antony A Peng S Fitzpatrick MG Intravenous vitamin C administration improved blood cell counts and health-related quality of life of patient with history of relapsed acute myeloid leukaemia Antioxidants 7 7 2018 92 30012948 PMC6070822
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The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review
Zambrano-Villacres, R., Arteaga-Pazmiño, C., Guevara Castillo, W. D., Herrera-Fontana, M. E., Domínguez Brito, L. D., Becerra Granados, L. M., Recoba-Obregón, P. E., Rodríguez-Veintimilla, D., Bressi, V., Andrade-Molina, D., et al. (2026) · Applied Sciences · doi:10.3390/app16020845 · Cited by 5 · see citing works
- Authors
- Milbar, H. C., Caplan, A., Schwab, R. D., Coromilas, A. J., Baumrin, E., Forrestel, A., Steele, K. T., Micheletti, R. G., Perl, A., & Rosenbach, M.
- Affiliations
- University of Pennsylvania (US)
- New York University (US)
- Abramson Cancer Center (US)
- Corresponding author
- Milbar, Heather C.
- ORCID
- Venue
- Blood Advances
- Publisher
- American Society of Hematology
- Published
- 2023-09-29
- Volume
- 7
- Issue
- 19
- Pages
- 5780-5783
- ISSN
- 2473-9529 (ISSN-L)
- 2473-9537
- PMC
- PMC10560999
- OpenAlex
- W4383873749
- Cited by
- 6
- References
- 2
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Blood Advances (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinoids in leukemia and cellular processes
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Keywords
- scurvy, acute myeloid leukemia, vitamin C, hypovitaminosis C, serum vitamin C, mucocutaneous manifestations, prolyl hydroxylase, lysyl hydroxylase, collagen cross-linking, oral ulcers, gingival hypertrophy
- MeSH terms
- Ascorbic Acid Deficiency, Humans, Leukemia, Myeloid, Acute
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