Dear Jonathan

Yes, it was all gloom.

England deserved to win.

The All Blacks had not lost for 20 matches and had not lost in Europe since 2002.

As you well know there is always reversion to the mean.

Hope to see you at the next world cup match AB vs E.

In Auckland community pathology we receive serum vitamin B12 requests: 1 B12 request for every 7 people pa, an enormous workload. Yes education is required but there is no medical political drive.

27% of results have a serum B12 110 – 240 pmol/L. 110 is the lower reference range and the cutoff 240 is derived from the data for the Siemens assay, interference due to IF Ab, see Carmel, R Failures of Cobalamin Assays in Pernicious Anemia NEJM 367; 4 July 26, 2012.

2.3% of the patients with B12 110 – 240 have a Hb < lower reference range.

To provide an MMA assay for 27% of the B12 results would probably not receive funding from the commissioners. It is probably cheaper to prescribe B12.

Jeff

From: Jonathan Kay [mailto:[log in to unmask]]
Sent: Friday, 7 December 2012 10:15 a.m.
To: Jeffrey Barron
Cc: <[log in to unmask]>
Subject: Re: Folate/B12

More detail on that, please, Jeff.

Jonathan

PS: How did the England match go down in Auckland?

On 6 Dec 2012, at 21:05, Jeffrey Barron wrote:

It is impractical in current clinical practice to use MMA to diagnose B12 deficiency.

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