B12 Tests Research Articles

Preparation and Characterization Silver Nanoparticle Embedded Polyamide Nanofiltration (NF) Membrane

In this study, silver nanoparticles (AgNPs) were synthesized from tea leaves extract and its antimicrobial properties was tested on Escherichia coli (E. coli) using agar well method. The synthesized nanoparticles were characterized by using UV-vis spectroscopy, transmission electron microscopy (TEM) and X-ray diffraction (XRD). The result from XRD analysis shows that the synthesized AgNPs are a face-centered cubic (fcc) structure with an average particle size of 28±15 nm AgNPs which confirmed by TEM. The synthesized AgNPs were then used in the preparation of thin film composite NF membrane via interfacial polymerization method. Separation performance of the produced membrane was evaluated in term of membrane permeability and solute rejection (vitamin B12, NaCl and Na2SO4 solutions). Based on the structural parameters (pore size, rp and Δx/Ak) values obtained from vitamin B12 test, all membranes can be considered as tight NF membranes. From the salts rejection test, membranes with the addition of AgNPs exhibited higher salt rejection compared to the neat membranes.

Measurement of total Transcobalamin employing a commercially available assay for Active B12

IntroductionVitamin B12 deficiency is mostly caused by insufficient gastro-intestinal absorption and in rare conditions by Transcobalamin (TC) deficiency. Unsaturated Transcobalamin (apoTC) can be measured by a binding assay using radiolabeled cobalamin. The Active B12 test analyzes saturated Transcobalamin (holoTC) and we hypothesize that this test can be used to measure total TC by additional in vitro saturation with cobalamin. MethodsSerum was saturated in vitro (16 times dilution) with a cyanocobalamin solution and total TC was selectively measured with the Abbott Active B12 test. ApoTC was calculated by subtracting endogenous holoTC from total TC after correction for dilution. Linearity was determined with a pool serum dilution series. Precision was investigated according to the CLSI EP15 protocol. Method comparison was performed against a binding assay using radiolabeled cobalamin. Reference values were determined in 100 healthy controls. ResultsThe method was linear in the range of 240 to 1933pmol/L (R2=0.997, lack of fit F=1.61). Precision of low- and high-pool total TC in serum were; 5.2% and 4.3% respectively. Method comparison against a radiolabeled cobalamin binding assay showed a proportional bias of 30% (y=0.70x+126). Total TC reference values were determined at 500–1276pmol/L. ConclusionWe describe a rapid method to quantify total TC, which can be implemented on routine platforms using commercial Active B12 tests. In addition, apoTC can be assessed by subtracting endogenous holoTC concentration which can be measured in the same run, securing the same calibration level for all three parameters (holoTC, apoTC and total TC). This method is applicable in clinical diagnostics and in larger epidemiological studies.

Haemato-biochemical basis of anaemia in Agogo, Ashanti Region, Ghana

This cross sectional study was conducted to evaluate the underlying causes of anaemia among 200 adult patients (18-60 years) without any established chronic disease from September 2011 to February 2012 at the outpatients department of the Agogo Presbyterian Hospital. Participant selection was based on the WHO definition of anaemia in adults [Hb<12.0g/dl (female) and Hb<13.0g/dl (male)]. Venous blood samples were drawn for full blood count (FBC), total iron, ferritin, folate, vitamin B12 and malaria parasite tests. One hundred and forty-eight (74%) of the study participants presented with mild anaemia, 40(20%) had moderate anaemia and 12(6%) had severe anaemia. Study participants with mild anaemia presented with higher mean red blood cell count (4.14±0.51 M/μL) when compared to those with moderate (3.71±0.67 M/μL) and severe (2.30±0.73 M/μL) anaemia. About one quarter (51/200) of the study participants had folate deficiency (serum folate <5.0 ng/ml) and 60/200 had vitamin B12 deficiency (serum vitamin B12<200ng/L). Iron deficiency (serum iron <8.9 µmol/L), the most prevalent cause of anaemia, occurred in 69/200 of the study participants and had a statistically significant association with the severity of the anaemia (p=0.0028). Malaria infection increased the risk of mild to moderate anaemia (OR=5.2; 95%CI=2.0-13.5) five times and mild to severe anaemia (OR=6.9; 95%CI=1.8-26.9) seven times. Deficiencies in iron, vitamin B12 and folic acid are significantly associated with the burden of anaemia in Agogo, Ashanti. It is imperative that the cause of anaemia be fully investigated to enable medical interventions to be fashioned around the underlying aetiology thus optimizing the use of limited health resources associated with the burden of anaemia in Agogo-Ashanti.Journal of Medical and Biomedical Sciences (2016) 5(3), 1-12Keywords: Anaemia, Microcytosis, Hypochromasia, Immunoassay, Agogo, Ghana, Malaria

Primary care requests for anaemia chemistry tests in Spain: potential iron, transferrin and folate over-requesting

AimTo study the regional variability of requests for anaemia chemistry tests in primary care in Spain and the associated economic costs of potential over-requesting.MethodsRequests for anaemia tests were examined in...

Long-term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans.

To examine the association between long-term metformin therapy and serum vitamin B12 monitoring. Retrospective cohort study. A single Veterans Affairs Medical Center (VAMC), 2002-2012. Veterans 50 years or older with either type 2 diabetes and long-term metformin therapy (n = 3,687) or without diabetes and no prescription for metformin (n = 13,258). We determined diabetes status from outpatient visits, and defined long-term metformin therapy as a prescription ≥500 mg/d for at least six consecutive months. We estimated the proportion of participants who received a serum B12 test and used multivariable logistic regression, stratified by age, to evaluate the association between metformin use and serum B12 testing. Only 37% of older adults with diabetes receiving metformin were tested for vitamin B12 status after long-term metformin prescription. The mean B12 concentration was significantly lower in the metformin-exposed group (439.2 pg/dL) compared to those without diabetes (522.4 pg/dL) (P = .0015). About 7% of persons with diabetes receiving metformin were vitamin B12 deficient (<170 pg/dL) compared to 3% of persons without diabetes or metformin use (P = .0001). Depending on their age, metformin users were two to three times more likely not to receive vitamin B12 testing compared to those without metformin exposure, after adjusting for sex, race and ethnicity, body mass index, and number of years treated at the VAMC. Long-term metformin therapy is significantly associated with lower serum vitamin B12 concentration, yet those at risk are often not monitored for B12 deficiency. Because metformin is first line therapy for type 2 diabetes, clinical decision support should be considered to promote serum B12 monitoring among long-term metformin users for timely identification of the potential need for B12 replacement.

Holotranscobalamin (HoloTC, Active-B12) and Herbert's model for the development of vitamin B12 deficiency: a review and alternative hypothesis.

The concentration of total vitamin B12 in serum is not a sufficiently sensitive or specific indicator for the reliable diagnosis of vitamin B12 deficiency. Victor Herbert proposed a model for the staged development of vitamin B12 deficiency, in which holotranscobalamin (HoloTC) is the first indicator of deficiency. Based on this model, a commercial immunoassay has been controversially promoted as a replacement for the total vitamin B12 test. HoloTC is cobalamin (vitamin B12) attached to the transport protein transcobalamin, in the serum, for delivery to cells for metabolism. Although there have been many published reports supporting the claims for HoloTC, the results of some studies were inconsistent with the claim of HoloTC as the most sensitive marker of vitamin B12 deficiency. This review examines the evidence for and against the use of HoloTC, and concludes that the HoloTC immunoassay cannot be used to measure vitamin B12 status any more reliably than total vitamin B12, or to predict the onset of a metabolic deficiency, because it is based on an erroneous hypothesis and a flawed model for the staged development of vitamin B12 deficiency. The author proposes an alternative model for the development of vitamin B12 deficiency.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2252-z) contains supplementary material, which is available to authorized users.

Experimental vitamin B12 deficiency in a human subject: a longitudinal investigation of the performance of the holotranscobalamin (HoloTC, Active-B12) immunoassay.

Based on Victor Herbert’s model for sequential stages in the development of vitamin B12 deficiency, the holotranscobalamin (HoloTC) immunoassay has controversially been promoted as a more specific and sensitive replacement for the total vitamin B12 test, for the diagnosis of deficiency. There have been no longitudinal studies, by means of experimental cobalamin deficiency, because ethical considerations prevent such risky studies on patients or healthy human volunteers. The objective was to provide a detailed record of the response of HoloTC, compared to total vitamin B12 and metabolites, to the development of experimental vitamin B12 deficiency in an initially replete human subject. This 54 year old male, with a vitamin B12 deficiency possibly caused by a defect in the intracellular cobalamin metabolism, ensured an initially replete condition by means of oral doses of cyanocobalamin supplements at 1000 μg/day for 12 weeks. The subject then depleted himself of vitamin B12, by withholding treatment and using a low-cobalamin diet, until significant metabolic disturbances were observed. The responses of serum total vitamin B12 and HoloTC and the two metabolites, plasma methylmalonic acid and homocysteine, were monitored by weekly blood tests. HoloTC was not significantly more sensitive than either total serum vitamin B12 or total homocysteine, and was much less sensitive than methylmalonic acid. HoloTC decreased from an initial concentration of >128 pmol/L to a minimum of 33 pmol/L on day 742, the only day on which it fell below the lower limit of the reference interval. Total vitamin B12 decreased from an initial concentration of 606 pmol/L to a minimum of 171 pmol/L on day 728. Total homocysteine increased from an initial concentration of 8.4 μmol/L to a maximum of 14.2 μmol/L on day 609. Methylmalonic acid unexpectedly contained four distinct peaks; initially at 0.17 μmol/L, it first exceeded the upper limit of the reference interval on day 386, finally reaching a maximum peak of 0.90 μmol/L on day 658. The results of this experiment are inconsistent with Herbert’s hypothesis that HoloTC is the earliest marker of vitamin B12 deficiency, and therefore do not support his model for the staged development of vitamin B12 deficiency.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-1740-5) contains supplementary material, which is available to authorized users.

Vitamin B12 screening in metformin-treated diabetics in primary care: were elderly patients less likely to be tested?

Low serum B12 level is a common occurrence in patients with type 2 diabetes (T2DM) treated with metformin. There is lack of evidence concerning blood testing of vitamin B12 and current clinical guidelines make no recommendations on the detection or prevention of vitamin B-12 deficiency during metformin treatment. Our objective was to examine the current practice and clinical determinants of vitamin B12 testing in metformin treated T2DM patients. Data were collected from health maintenance organization patients, and consisted of T2DM patients who were newly prescribed metformin from 2008 to 2013. Patients were randomly divided into two subgroups: referred for a vitamin B12 blood test, and did not receive a referral. The demographic data and medical characteristics were analyzed. 5131 patients began taking metformin during the study period. Of these 2332 (44.5%) had vitamin B12 tested. Significant differences were found between the groups in regard to glycosylated hemoglobin, low density lipoprotein, systolic blood pressure, dyslipidemia, chronic renal failure, and disease duration. A significant positive association (p<.05) was found between vitamin B12 testing and insulin treatment, retinopathy, neuropathy and hypertension. Vitamin B12 in elderly (>75years) patients was significantly lower (p<.01). Insulin treatment, hypertension, and chronic diabetic complications in metformin treated T2DM patients are associated with higher rates of vitamin B12 testing. T2DM patients 75years and above were less likely to be tested for B12 deficiency.

Clinicoepidemiological Observational Study of Acquired Alopecias in Females Correlating with Anemia and Thyroid Function.

Alopecia can either be inherited or acquired; the latter, more common, can be diffuse, patterned, and focal, each having cicatricial and noncicatricial forms. This observational study of 135 cases in a semiurban Indian population aimed to detect the prevalence of various forms of acquired alopecia in females and correlate the same with levels of hemoglobin, serum ferritin, triiodothyronine, thyroxin, and thyroid stimulating hormone. The majority (84, 62.2%) of our cases of alopecia had telogen effluvium followed by female pattern alopecia (32, 23.7%). Stress (86, 63.7%), topical application of chemicals (72, 53.3%), systemic medications for concurrent illnesses (62, 5%), and pregnancy (14, 10.3%) were the common exacerbating factors. Neither low hemoglobin (<12 gm%, 73.4%) nor low serum ferritin (<12 μg/L, 6.7%) was found to be statistically significant. A majority (90, 90.9%) of 99 cases with anemia (hemoglobin levels of <12 gm%) had serum ferritin levels >12 μg/L. Though lack of vitamin B12 testing was a limitation of our study, its deficiency could be the probable cause of iron deficiency as the majority (58, 64.4%) of these cases, as indeed majority (89, 65.4%) of our study population, were vegetarians. Thyroid disorders (23, 17%, including 9 newly diagnosed) were not of significance statistically.

Vitamin B12 Deficiency in Diabetic Patients on Chronic Metformin Therapy

Introduction: Since its approval and universal acknowledgement in the 1990's as a first line agent for the treatment of Diabetes Mellitus Type II, studies have shown vitamin B12 deficiency to be a complication of chronic metformin therapy. Despite this awareness and few studies aimed at the general population, a systematic assessment of the prevalence of vitamin B12 deficiency in Type II diabetics on metformin in the veteran population has not been performed. Methods: A retrospective data analysis at a VA Hospital from 2002-2012 was performed which included 3844 diabetic patients on metformin who had B12 levels drawn while on metformin. Vitamin B12 deficiency was defined as B12 ≤ 218 pg/mL and further subdivided into moderate (218-175 pg/mL) and severe (1500 mg/day). The duration of metformin therapy was categorized as short (4 years) and long (>4 years). Results: Overall prevalence of B12 deficiency while on metformin therapy was 9.8 %. Only 38 % of the patients had baseline B12 levels checked prior to their becoming deficient. There was a significant difference when comparing B12 deficiency between control vs. metformin group (P < 0.0001 CI (2.5-10.6), OR 5.1, and Metformin vs. Insulin group P < 0.0001, CI (0.13-1.43), OR 11.6 (Table 1). There was a significant difference between short duration vs. long duration of metformin in regards to moderate vs. severe B12 deficiency (Table 2). In addition, there was a significant difference between low dose metformin group and high dose metformin group in regards to moderate vs. severe B12 deficiency (Table 2).Table 1: P value, Confidence Interval, and OR for Control vs. Metformin vs. Insulin.Table 2: Comparison of Duration and Dosing of Metformin therapy vs. B12 deficiencyConclusion: We report 9.8% overall prevalence of patients with B12 deficiency while on metformin. Compared to insulin-treated diabetics and non-diabetics, metformin group had significantly more patients with overt B12 deficiency (B12 < 218 pg/mL). Higher dose and longer duration appear to worsen the problem. B12 deficiency develops gradually and is frequently overlooked although it is easy to treat if suspected and managed in time. Our study highlights the lack of awareness of this important problem as evidenced by the small percentage of veterans that had undergone prior B12 testing (38%). Primary care providers and specialists need to be cognizant of the necessity of Vitamin B12 testing with chronic metformin therapy.

PTH-249 Contraceptive pill and b12: low yield from investigating low serum b12 in women taking the ocp

Introduction Vitamin B12 deficiency causes megaloblastic anaemia, cytopenias and neurological deficits and deficiency is usually a result of defective absorption, either through lack of intrinsic factor, gastric pathology or ileal pathology although dietary deficiency may occur. Serum B12 assays have low specificity and up to 50% of results below 200 ng/l appear erroneous. Patients could be committed to unnecessary B12 replacement therapy and symptoms may be wrongly ascribed to B12 deficiency as the real cause is overlooked. 70–90% of serum B12 is bound to holohaptocorrin, the remainder being bound to holotranscobalamin. These carrier proteins are affected by pregnancy and the oral contraceptive pill (OCP), resulting in a low B12 level in the absence of anaemia or macrocytosis. Our aim was to evaluate B12 testing in women of childbearing age by assessing firstly, concomitant use of the OCP and secondly where, the result was felt to indicate true deficiency, whether appropriate assessment was conducted. Method Over a 12-month period, all women of childbearing age who were shown to have a low serum B12 level were eligible to be included. Repeat tests were excluded. We then reviewed Hb, MCV and ferritin and folate. Results of investigation were noted when performed including intrinsic factor, anti-GPC and TTG antibodies; endoscopy and small bowel imaging. Results 180 case records were identified, complete data was available from 166. The two key groups are those with isolated low B12 and those with macrocytic anaemia. Of those with macrocytic anaemia, 4/10 had coexisting folate deficiency. Further assessment was inconsistent- 4/10 no further assessment, 2/10 further blood tests but no imaging and 4/10 had various tests. One patient was subsequently diagnosed with Crohn’s disease. Those patients with an isolated low B12 result, 68 were taking the OCP. For the remainder there was no documentation to confirm or deny use. Of the 68 patients, 30/68 had undergone some form of further investigation. In 2/30 women taking the OCP with low B12 without anaemia, one had coeliac disease and one had anti-GC antibodies (but no IF antibodies). Conclusion In those patients who are identified as having a low B12 level in the absence of anaemia or macrocytosis; use of the OCP should be considered. Investigation of low B12, when there is no anaemia and normocytosis, is unrewarding. Repeating the serum B12 level after stopping the OCP should confirm the cause and prevent unnecessary investigation. Where anaemia or macrocytosis is present a structured approach to further investigation should made to seek and identify significant pathology. This includes antibody testing, thyroid function and gastric + ileal assessment. Disclosure of interest None Declared.

Iron deficiency anemia in women: a practical guide to detection, diagnosis, and treatment.

Iron deficiency anemia (IDA) remains a widely underdiagnosed and unappreciated women's health issue, affecting women of all ages. Despite the fact that IDA is easily diagnosed and treated, it continues to be a major public health issue. The World Health Organization estimates that 30% of nonpregnant and more than 42% of pregnant women have anemia. A multidisciplinary Group for the Research and Education on Anemia Therapy in Women (GREAT Women II) was formed, sponsored by the Society for the Advancement of Blood Management. The goal was to focus attention on the impact of IDA on women at various stages of life and evaluate and use published literature to provide a simple, evidence-based approach to diagnose and treat IDA. The group developed specific recommendations for evaluating and treating IDA in women. Initial diagnosis is defined as hemoglobin less than 12 g/dL in nonpregnant women. A trial of iron therapy (4 weeks) can be considered a first-line diagnostic tool. Alternatively, a low or normal mean corpuscular volume (<100 fL), low serum ferritin (<30 μg/L), and/or low transferrin saturation (transferrin saturation <20%) is sufficient to confirm IDA. If the patient does not fit the diagnosis of IDA or fails to respond to a trial of oral iron, or mean corpuscular volume is elevated, further diagnostic evaluation is needed, including iron studies, B12, folate levels, and renal function tests. If results are not definitive, and IDA persists, a hematology referral is recommended. Clinicians should routinely identify and treat IDA, thereby decreasing its negative impact on health and quality of life of women.

Reference Range Estimation: Accounting for Measurement System Errors

Reference range is a statistic that is used in health related fields to represent the range of the most likely values for a variable of interest. Based on this range, individuals are classified as being healthy or unhealthy. In biostatistics, the reference range is calculated as the (1 − α)% prediction interval, where this prediction interval is based on the estimated population variance from the data. Such estimation of population variance is not precise, because obtained test results do usually have errors associated with them. These errors are due to the imprecise test procedure or gauge used. In this paper, the total variability in the data is decomposed into two categories. The first is the patient‐to‐patient variability and the other is the variability due to the measurement system used. Estimation of the two kinds is performed through a gauge repeatability and reproducibility study, then the reference range is calculated, taking into account only the patient‐to‐patient variability. The revised reference range procedure is illustrated through a case study of vitamin B12 test results. A closed form formula is given to calculate the probability of a given test result being within the revised reference range. Copyright © 2015 John Wiley &amp; Sons, Ltd.

Serum Vitamin B12 Levels in Two Subpopulations of Healthy Workers in Israel: Differences by Land of Birth

Background: Clinical and subclinical vitamin B12 deficiency rates are lower in western populations compared to developing populations and cut-off points for defining deficiency are inconsistent. Objectives: The present study was designed to examine variability in vitamin B12 blood levels in a heterogeneous population. Methods: The present report is a cross-sectional analysis of serum vitamin B12 levels recorded for 1969 apparently healthy hospital workers employed at Tel Aviv Medical Centre, Tel Aviv, Israel, who underwent blood vitamin B12 tests evaluation as part of the routine occupational health evaluation. Data were extracted from the electronic employee medical record. Results: Almost 73% of the study population was born in Israel, and 73.6% of the population was female. Serum vitamin B12 levels were significantly lower in Israeli born women than in women born outside of Israel: 294±119.9 vs. 320±121.7pmol/L. Land of birth and sex were significant, independent predictors of serum vitamin B12 levels even after controlling for age and year in which the serum vitamin B12 was measured. In a logistic regression model of serum vitamin B12 < 350 pmol/L, land of birth emerged as the only significant, independent predictor, such that being born in Israel increased odds of serum vitamin B12 < 350 pmol/L by a relative 44% (95% CI 17-78%, p=0.001). Discussion: Wide serum vitamin B12 level variability in heterogeneous populations suggests that cut-offs for deficiency may need to be subgroup-specific in order to be clinically meaningful. It is not clear whether presently used clinical cut-offs are associated with increased morbidity in a given population.

Tracing a roadmap for vitamin B12 testing using the health technology assessment approach

In our hospital, we are currently working to manage the appropriateness of vitamin B₁₂ (B12) testing. Unfortunately, the classic evidence-based approach is unhelpful in this process and meta-analyzing data on the accuracy of this marker for cobalamin deficiency detection is misleading due to the lack of reference diagnostic methods. The approach currently proposed by the Health Technology Assessment (HTA) enables us to tackle the issue of B₁₂ requests as a "healthcare" problem by considering the position of stakeholders involved in ordering, performing, interpreting the test, and receiving its results. Clinical expectations, methodological issues, and ethical aspects concerning the performance of the test can aid us in providing more guidance on the use of this marker. By building such structured information, hemodialysis patients and pregnant women have emerged as those groups preferentially requiring B₁₂ testing, as it may potentially improve the clinical outcome. To avoid misinterpretation of B₁₂ results more care should be taken in considering its biochemical and biological features, as well as the analytical issues. Spurious values obtained by current automated immunoassays may reflect suboptimal pre-analytical steps as well as known interfering conditions. Furthermore, the harmonization of results by available methods is still a far-reaching goal and the approach to interpret an individual's results should be improved. Tracing a roadmap for B₁₂ testing by exploiting the HTA model to balance the stakeholders' claims and maximizing the patient's outcome may help to manage the marker demand.

Vitamin B12 Deficiency In Patients With Normal Blood Count

BackgroundVitamin B12 (Cobalamine) is essential for protein synthesis, cell proliferation and optimal systemic function, particularly for nervous system and blood. Moderate vitamin B12 deficiency is common even with normal hematological parameters. Diagnosis and treatment are delayed because of non-specific symptoms, normal blood count and lack of awareness. ObjectivesTo find out the prevalence of hidden vitamin B12 deficiency in patients with normal blood count. Materials and MethodsWe reviewed the results of vitamin B12 tests which were ordered for patients at King Khalid University Hospital, King Saud University between 1st of January- 30thof December 2012. Those with low vitamin B12 and normal blood count were contacted and interviewed and were asked for consent to participate in this retrospective study and to answer detailed medical history questions on dietary habits, medical illnesses, gastro-intestinal surgical procedures, and long term medications. ResultsOut of 3045 patients, there were 415 (155 males and 260 females, aged 36 +/- 18 years) with normal blood count, but low vitamin B12 level, which was between 40-140 pmol/l ( normal 145-637). 350 patients agreed (81 males and 170 females), but complete information was obtained only from 251 patients (71.71%). Symptoms included fatigue, tingling and numbness, impaired short-term memory, insomnia and impaired concentration. Identified causes of Vitamin B12 deficiency were as follows: 65 patients (26%) had partial gastrectomy, 12 (5%) had resection of the terminal ileum, 16 (6%) had gastric atrophy, 18 (7%) had celiac disease, 36 (14%) were vegetarians, 49 (20%) were diabetic on metformin, 47 (19%) were on proton pump inhibitors, and in 8 (3%) the cause could not be identified. ConclusionVitamin B12 deficiency is common even in patients with normal hematological values. There is a need for continuous awareness program for physicians, dietitians, and general population to identify risk factors, and to implement guidelines for prevention, early detection and treatment of hidden Vitamin B12 deficiency. Disclosures:No relevant conflicts of interest to declare.

Anaemia in chronic heart failure: more awareness is required

To determine the characteristics of anaemic patients, how well anaemia is investigated and its contributing factors in patients with chronic heart failure (CHF). Retrospective analysis of longitudinal data collected during routine management of patients admitted with CHF at an Australian tertiary hospital. One thousand and twenty-one patients admitted with CHF between 1997 and 2005 were included. Anaemia was defined as a haemoglobin concentration <110 g/L. Data were compared between anaemic and non-anaemic patients. The prevalence of anaemia among patients with CHF was 20.3% in our study. These patients were more likely to be older, female, and have a higher prevalence of chronic renal failure and peripheral vascular disease. Despite previous studies reporting a higher mortality rate among CHF patients with anaemia, only 60% of patients had basic investigations for anaemia (i.e. iron studies, vitamin B12, folate and thyroid function testing). The cause of anaemia is usually multifactorial with 63.8% of patients having at least two factors contributing to their anaemia. Chronic renal failure, iron deficiency and anaemia of chronic disease were the most common contributors. These factors were not predicted based on abnormalities in mean corpuscular volume. Patients with anaemia had a longer length of stay in hospital. Anaemia in patients with CHF is common but not well investigated. The aetiology of anaemia is usually multifactorial and not easily predicted. Patients with anaemia and CHF have poorer outcomes. There needs to be more awareness among clinicians about the importance of investigating and treating anaemia in patients with CHF.

Dietary Intake of B Vitamins and Methionine and Colorectal Cancer Risk

B vitamins are involved in 1-carbon metabolism, which is necessary for DNA replication, DNA repair, and regulation of gene expression. Recent studies suggest inverse associations between folate and vitamin B6 intakes and colorectal cancer risk but associations with other B vitamins and methionine have not been widely studied. After following 14,645 men and 22,467 women for 15 yr on average, we ascertained 910 incident colorectal cancers. Dietary intakes were estimated using a 121-item food frequency questionnaire. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox regression. We found some evidence of a U-shaped relationship between colon cancer risk and vitamin B6 and an inverse U-shaped relationship between rectal cancer risk and B12 (test for the quadratic trend, P = 0.005 and P = 0.0005 respectively). For colon cancer, we observed a reduced risk associated with low methionine/high folate, HR = 0.63 (0.49, 0.80) and an increased risk associated with high methionine/high folate, HR = 1.36 (1.06, 1.74) (P interaction < 0.0001). Our study suggests a U-shaped association between colon cancer risk and vitamin B6 intake and an inverse U-shaped association between rectal cancer risk and vitamin B12. Adequate folate intake might protect against colon cancer risk in those with low methionine intake.

Vitamin B12 and folate tests: the ongoing need to determine appropriate use and public funding

[Extract] It's not as simple as new for old: we need to follow a process for “disinvestment” in existing medical procedures, services and technologies Criteria have been developed for assessing the safety, effectiveness and cost‐effectiveness of new and emerging health interventions, but additional challenges exist in identifying opportunities for reducing the use of existing health technologies or procedures that are potentially overused, (cost‐)ineffective or unsafe.1 Criteria have been proposed to flag technologies that might warrant further investigation under quality improvement programs.1 These criteria are: new evidence becomes available; there is geographical variation in use; variation in care between providers is present; the technology has evolved and differs markedly from the original; there exists a temporal trend in the volume of use; public interest or controversy is present; consultation with health care workers and funders raises concerns; new technology has displaced old technology; there is evidence of leakage (use beyond the restriction or indication); the technology or intervention is a “legacy item” that has never been assessed for cost‐effectiveness; use is not in accordance with clinical guidelines; or the technology is nominated by clinical groups. After such a nomination was made by members of the clinical laboratory community regarding vitamin B12 and folate tests, we sought to determine whether these tests met other criteria. We hope that this article will encourage debate and discussion about the appropriate use of these tests.

PWE-093 Screening with Holotranscobalamin is Superior to Serum B12 in Identifying Vitamin B12 Deficiency in Patients with Crohn’S Disease

IntroductionRisk factors for vitamin B12 deficiency in patients with Crohn’s disease (CD) include ileal disease and previous ileal resections. Screening for B12 deficiency is traditionally through serum B12 which is...