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Identification of patients with cobalamin deficiency crucially depends on the diagnostic strategy
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
 
ID 4626499
Author(s) Rothen, Jean-Pierre; Walter, Philipp N; Tsakiris, Dimitrios A; Infanti, Laura; Hersberger, Kurt E; Arnet, Isabelle
Author(s) at UniBasel Arnet, Isabelle
Rothen, Jean-Pierre
Walter, Philipp
Tsakiris, Dimitrios
Infanti, Laura
Hersberger, Kurt
Year 2021
Title Identification of patients with cobalamin deficiency crucially depends on the diagnostic strategy
Journal Clin Lab
Volume 67
Number 5
Pages / Article-Number 1229-1235
Mesh terms Biomarkers; Humans; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency, diagnosis
Abstract

Our goal was to determine vitamin B12 (cobalamin) deficiency with different diagnostic strategies, to propose the best possible laboratory strategy, and to synthesize the relevance of biomarkers in the diagnosis of a cobalamin deficiency.; We performed a secondary data analysis. The testing strategies were (i) vitamin B12 solely, (ii) holotranscobolamin solely, (iii) vitamin B12 and holotranscobolamin, and (iv) reflex testing of holotranscobalamin in samples with vitamin B12 < 300 pmol. A set of 3,044 laboratory samples with vitamin B12 and holotranscobalamin serum values from unselected in- and outpatients from a secondary care hospital. A sample was classified as cobalamin deficient when low values of vitamin B12 < 137 pmol/L or holotranscobalamin ≤ 37 pmol/L were measured.; Low cobalamin values were identified in 591 (19.4%) samples either according to low vitamin B12 values (305; 10.0%) or low holotranscobalamin values (436; 14.3%). For 2,404 values with vitamin B12 < 300 pmol/L, the additional measurement of holotranscobalamin (reflex-testing) enabled the detection of an additional 278 (9.1%) deficiencies. When the grey zone was decreased to 138 - 219 pmol/L, the reflex testing of an additional 1,240 samples identified a total of 511 (16.8%) samples as cobalamin deficient.; The identification of cobalamin deficiency or sufficiency highly depends on the diagnostic strategy. A reflex testing with a grey zone for vitamin B12 < 220 pmol/L identifies cobalamin deficiency cost efficiently in 86.5% cases (511 out of 591). Physicians should apply a uniform strategy on how to address the diagnosis of cobalamin deficiency and indication for treatment. In-hospital guidelines, which describe methodology and sensitivity of the locally used assays for vitamin B12 and holotranscobalamin could guide them.

ISSN/ISBN 1433-6510
Full Text on edoc
Digital Object Identifier DOI 10.7754/Clin.Lab.2020.200912
PubMed ID http://www.ncbi.nlm.nih.gov/pubmed/33978377
   

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