The limited value of methylmalonic acid, homocysteine and holotranscobalamin in the diagnosis of early B12 deficiency
Goringe A, Ellis R, McDowell I, Vidal-Alaball J, Jenkins C, Butler C, Worwood M.
Department of Haematology, University Hospital of Wales, Cardiff CF14 4XN, UK.

Treatment of B12 deficiency is important to prevent progressive neurological and/or hematologic disease but requires a secure diagnosis. The aim of this study was to evaluate second line tests of B12 status as prognostic indicators of a hematologic response to vitamin B12 therapy. Forty-nine patients referred with low, serum vitamin B12 concentrations were treated with intramuscular B12 and re-assessed after 3 months. Methylmalonic acid, homocysteine, holotranscobalamin and neutrophil hypersegmentation index were measured before and after treatment. Before treatment 27/49 patients were anemic or macrocytic of whom 15 had a clear hematologic response. All the tests had a similar prognostic accuracy. Symptomatic improvement did not correlate with hematologic response. Supplementary tests of vitamin B12 status were not significantly better than total serum B12 concentration as predictors of a hematologic response to vitamin B12 therapy

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8-11 December, 2007
American Society of Hematology, Atlanta, booth 544
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