THE VITAMIN B12 AND FOLATE PATHOLOGY INVESTIGATION
THE INVESTIGATION OF ERRORS IN PATHOLOGY TESTS
FOR VITAMIN B12 AND FOLATE DEFICIENCY
BY MEANS OF MEDICAL EXPERIMENTS
B12 AND FOLATE INFORMATION
B12 NOTES
Serum B12
Tests
Suggested Procedure
Treatment
Sources of Information

I suggest the following approach:

1. Firstly, before commencing any treatment, test for all of the following:

  • Total serum B12
  • Active B12 (holotranscobalamin, HoloTC)
  • Serum Methylmalonic acid
  • Total homocysteine

I suggest that you should not test for either total serum B12 or active B12 first, and then only do the Methylmalonic acid or total homocysteine if the total serum B12 or active B12 is low. My reasons for testing for both MMA and tHcy immediately are as follows:

  • In addition to warnings by experts, as cited elsewhere on this web site, my own test results show that it is possible to have cellular deficiency of vitamin B12 without having low total B12.
  • My own results show that it is possible for MMA to indicate the onset of cellular deficiency before tHcy increases above baseline levels. It might be possible that, in other patients, the tHcy will increase first.

2. If the tests in step 1 show a B12 deficiency, then test for both of the following:

  • Intrinsic Factor Antibodies
  • Parietal Cell Antibodies.

This pair of antibody tests is used to check for any evidence of Pernicious Anaemia (PA).

3. If B12 deficiency is shown in step 1, then immediately commence treatment after doing step 2, using either of the following:

  • High-dose oral B12 supplements
  • B12 injections

See the Treatment page for details of options and precautions for these treatments.

4. Wait for two weeks, after commencing treatment, and repeat these tests:

  • Total serum B12
  • Active B12 (holotranscobalamin, HoloTC)
  • Serum Methylmalonic acid
  • Total homocysteine

If either MMA or tHcy was high, and falls significantly after treatment, then according to experts, this indicates that there was B12 deficiency.

For a very detailed report on this method see reference DA08, Evaluation of Indicators of Cobalamin Deficiency Defined as Cobalamin-induced Reduction in Increased Serum Methylmalonic Acid, Bolann et al, Clinical Chemistry. 2000;46:1744-1750, on my References page.

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