Abstract
The Application of Holotranscobalamin and Methylmalonic Acid in Hospital Patients and Total Vitamin B12 in Primary Care Patients to Assess Low Vitamin B12 Status
Highlights
Vitamin B12 deficiency is common, with significant and variable clinical sequelae [1,2]
The incidence of elevated methylmalonic acid (MMA) in the small group of external patients was high; suggesting that the application of total B12 alone may not identify all patients with low vitamin B12 status, and that MMA is a useful marker in confirming B12 status
Macrocytosis is the most common reason that B12 status is investigated. These pathological changes are a late haematological manifestation of an advanced low B12 status only. It is not uncommon for neuropathy and neuropsychiatric changes as a consequence of low B12 status to occur in the absence of macrocytosis or anaemia [4]
Summary
Vitamin B12 (cobalamin) deficiency is common, with significant and variable clinical sequelae [1,2]. Deficiency is prevalent in the general ostensibly healthy elderly population affecting ~5% of those aged 65-74 years, increasing to >10% in those >75 years [3]. It is typically the clinical presentation that is the primary factor when assessing the significance of laboratory generated test results, in the case of B12 this is problematic because of the variability and severity of symptoms. Low vitamin B12 (B12) status is common in patient populations. Prompt diagnosis is recognised as problematic especially when status is estimated using total B12 abundance in serum as the sole laboratory indicator. Functional markers of B12 utilisation e.g. elevations in serum methylmalonic acid (MMA) concentration, can complement the assessment of B12 status
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