Approaches to vitamin B12 deficiency

摘要: A 28-year-old female vegetarian was referred to a specialist in internal medicine with persistent iron deficiency. Laboratory analysis revealed microcytic anaemia low ferritin levels but normal total vitamin B12 levels. The red blood cell distribution width, however, showed very wide variation sizes, indicating coexisting deficiency, which confirmed by the concentration of active B12. Another patient, 69-year-old woman history previous gastric surgery and renal insufficiency as complication diabetes mellitus, suspected be deficient B12, she had an accumulation methylmalonic acid homocysteine her blood. Testing alone has insufficient diagnostic accuracy no accepted gold standard is available for diagnosing With development newer tests, such measuring holotranscobalamin II (concentration B12), atypical subclinical deficiency states can recognized. new approach presented, based upon these 2 case descriptions.