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
THE HOMOCYSTEINE INVESTIGATION
HCY ERRORS
Summary
Laboratory Performance
Interpretation Errors
Erroneous Normal Levels
Immunoassays

Sullivan Nicolaides Pathology incorrectly quotes a limit of 15.0 umol/L for total homocysteine (so also does the RCPA Manual, reference AF05):

A homocysteine level of 15.0 umol/L is not considered safe by most experts, including authors of reference AE11 and AE12. Both of these expert groups recommend a maximum level of 12.0 umol/L. Here is the diagnostic flowchart for homocysteine, as shown in reference AE12:

D.A.C.H. - Liga Homocystein

As you can see, a level of > 12 umol/L is considered high for a healthy population; a level > 10 umol/L is high for those patients at risk for cardiovascular disease.

Another expert report by Rasmussen et al, reference AF01, provides a range of age and gender-specific reference intervals. For a male aged 30 to 59 years, the recommended limit is 11.2 umol/L.

Reputable laboratories use much lower levels than the 15.0 umol/L quoted by SNP; several are listed in reference AF8 to AF22. This table lists some of these limits, in umol/L:

-
Mayo
Cleveland
Calgary
Cedars-Sinai
Sundhed
Male
<13
13.7
13.7
12.0
11.2 - 12.0
Female
<13
12.9
9.9 - 12.8
10.0
11.2 - 12.0

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