I commonly encounter simmilar situations in daily practice.There are far more veg in India than UK.
What about the cognitive/CNS findings in this patient.I have seen Vit B12 defn with abnormal cognitive functions but normal hematological indices.
MMA and holotranscob might be helpful.But if the patient is symptomatic a simple therapeutic trial of Vit B12 can be tried.It works!
Regards,
Dr Sutirtha Chakraborty, MD
Peerless Hospital,
India
-----Original message-----
From: Barlow Ian (NORTHERN LINCOLNSHIRE AND GOOLE HOSPITALS NHS FOUNDATION
TRUST)
Sent: 05/12/2012, 10:16 pm
To: [log in to unmask]
Subject: Re: Vitamin B12 testing in vegans
Fair comment Ahmed,.........
But then you could ask - what is the "normal" Hb and MCV for any given individual?
The result could sit within the reference range but be quite "abnormal" for that particular patient.
Regards
Ian
________________________________
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Waise, Ahmed
Sent: 05 December 2012 16:27
To: [log in to unmask]
Subject: Re: Vitamin B12 testing in vegans
Or educate users in not requesting B12 as part of TATT because we really do not know what these borderline values mean when HB and MCV are normal.
Difficult to interpret serum B12 values are to be followed by homocystine, MMA, Holo-TC,...anything else?
Ahmed Waise
Laboratory Medicine
York Hospital
________________________________
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Barlow Ian (NORTHERN LINCOLNSHIRE AND GOOLE HOSPITALS NHS FOUNDATION TRUST)
Sent: 05 December 2012 12:09
To: [log in to unmask]
Subject: Re: Vitamin B12 testing in vegans
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Or measure Holotranscobalamin instead?
Ian
________________________________
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay
Sent: 05 December 2012 12:03
To: [log in to unmask]
Subject: Re: Vitamin B12 testing in vegans
1 All vegans should take B12 supplements.
2 What's the clinical question here? Does the patient have anything suggesting B12 deficiency, or is she just generally worried or interested?
3 I think we'll all be doing a lot more methylmalonic acid assays in the future as the limitations and non transferability of current B12 assays and the clinical effects of B12 deficiency both become more widely known.
Jonathan
On 5 Dec 2012, at 11:46, Sally Brady wrote:
Dear collective brain,
I have had a GP write to me asking for some help as one of his vegan patients presented him with the following information from the Vegan Society. Was anyone else aware of this and how did you deal with it?
Testing B12 status
A blood B12 level measurement is a very unreliable test for vegans, particularly for vegans using any form of algae. Algae and some other plant foods contain B12-analogues (false B12) that can imitate true B12 in blood tests while actually interfering with B12 metabolism. Blood counts are also unreliable as high folate intakes suppress the anaemia symptoms of B12 deficiency that can be detected by blood counts. Blood homocysteine testing is more reliable, with levels less than 10 micromol/litre being desirable. The most specific test for B12 status is methylmalonic acid (MMA) testing. If this is in the normal range in blood (<370 nmol/L) or urine (less than 4 mcg /mg creatinine) then your body has enough B12. Many doctors still rely on blood B12 levels and blood counts. These are not adequate, especially in vegans.
http://www.vegansociety.com/lifestyle/nutrition/b12.aspx
Thanks,
Sally
Dr Sally Brady
Senior Clinical Scientist
Blood Sciences
The Hillingdon Hospital
01895 279924
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