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Diagnosis is not always straightforward as serum levels can be falsely high or normal. [11] Elevated methylmalonic acid levels may also indicate a deficiency. [2] Individuals with low or marginal values of vitamin B 12 in the range of 148–221 pmol/L (200–300 pg/mL) may not have classic neurological or hematological signs or symptoms. [2]
Diagnosis is supported based on vitamin B 12 blood levels below 150–180 pmol/L (200–250 pg/mL) in adults. [50] However, serum values can be maintained while tissue B 12 stores are becoming depleted. Therefore, serum B 12 values above the cut-off point of deficiency do not necessarily confirm adequate B 12 status. [2]
Cyanocobalamin is a form of vitamin B. 12 used to treat and prevent vitamin B. 12 deficiency except in the presence of cyanide toxicity. [7][8][2] The deficiency may occur in pernicious anemia, following surgical removal of the stomach, with fish tapeworm, or due to bowel cancer.
Serum vitamin B12. Serum vitamin B12 is a medical laboratory test that measure vitamin B 12 only in the blood binding to both transcobalamins. [1] Most of the time, 80–94% of vitamin B 12 in the blood binds to haptocorrin, while only 6–20% is binds to transcobalamin ll. [2] Only transcobalamin ll is "active" and can be used by the body. [1]
Schilling test. The Schilling test was a medical investigation used for patients with vitamin B 12 (cobalamin) deficiency. [1] The purpose of the test was to determine how well a patient is able to absorb B12 from their intestinal tract. The test is now considered obsolete and is rarely performed, and is no longer available at many medical centers.
Serum concentrations above 50 ng/mL may be cause for concern. Common, most foods do not contain vitamin D, indicating that a deficiency will occur unless people get sunlight exposure or eat manufactured foods purposely fortified with vitamin D. Vitamin D deficiency is a known cause of rickets , and has been linked to numerous other health problems.
[56] [57] Low levels of serum vitamin B 12 may be caused by other factors than B 12 deficiency, such as folate deficiency, pregnancy, oral contraceptive use, haptocorrin deficiency, and myeloma. [57] High serum levels may caused by supplementing with vitamin B 12, present of antibodies to intrinsic factor, or due to underlying condition. [56]
In a newly diagnosed vitamin B 12-deficient patient, normally defined as when serum levels are less than 200 pg/ml, daily IM injections of hydroxocobalamin up to 1,000 μg (1 mg) per day are given to replenish the body's depleted cobalamin stores. In the presence of neurological symptoms, following daily treatment, injections up to weekly or ...