BMJ  2006;333 (19 August), doi:10.1136/bmj.333.7564.0-b

Serum vitamin B-12 assay results can mislead

When interpreting results of serum vitamin B-12 assays it is important to take into account the overall clinical picture. Devalia (p 385) describes two cases of paradoxical vitamin B-12 results, where meticulous clinical assessment—including assessment of autoimmune conditions and taking a family history—helped to decide on the best treatment. The first patient had symptoms and a family history of pernicious anaemia, macrocytic anaemia, and thyroid disease. Despite this three vitamin B-12 assays were normal. However, the patient responded fully to vitamin B-12 replacement therapy, and immunological analysis confirmed pernicious anaemia, preventing a potential misdiagnosis of myelodysplasia, which requires much more aggressive therapy. For more detail and the second case, please go to page 385.

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Relevant Article

Diagnosing vitamin B-12 deficiency on the basis of serum B-12 assay

Vinod Devalia
BMJ 2006 333: 385-386. [Extract] [Full Text] [PDF]