Correlation of Folic Acid and Vitamin B12 With Red Cell Parameters in Suspected Cases of Oral Cancer

Abstract

Background: Oral cancer (OC) is a leading cause of cancer-related mortality in South Asia, with gutka, paan masala, betel nut, and tobacco consumption identified as major risk factors. Micronutrient deficiencies, particularly vitamin B12 and folic acid, may contribute to hematological abnormalities and increase susceptibility to oral carcinogenesis. However, their association with red blood cell (RBC) parameters in high-risk populations remains underexplored. Objective: To investigate the correlation between serum vitamin B12 and folic acid levels with hematological indices, particularly mean corpuscular volume (MCV), in individuals with suspected oral cancer who engage in high-risk chewing habits. Methods: A cross-sectional observational study was conducted among 96 participants from a peri-urban community near Karachi, Pakistan. Hematological parameters (hemoglobin, RBC count, hematocrit, MCV, MCH, MCHC, RDW, platelets, ESR) were assessed using an automated hematology analyzer, and serum vitamin B12 and folic acid were quantified via electrochemiluminescence immunoassay. Statistical analysis involved t-tests and Pearson’s correlations (SPSS v25.0), with significance set at p < 0.05. Results: Mean MCV was elevated (96.2 ± 16.2 fL), with 45% and 32% of participants deficient in folic acid and vitamin B12, respectively. MCV correlated negatively with folic acid (r = -0.82, p < 0.001) and vitamin B12 (r = -0.83, p < 0.001). Participants with low vitamin levels exhibited significantly higher MCV and lower hemoglobin (p < 0.05). Conclusion: Deficiencies of vitamin B12 and folic acid are strongly associated with macrocytic changes in suspected OC cases, underscoring their role as early hematological markers for risk assessment.