Cooper, S.C.; Fisher, N.C.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA99
Academic Journal
Background: B12 deficiency is a common condition with variable presentation from differing pathological processes. We sought to audit the methods of investigating, diagnosing and managing B12 deficiency. Methods: Retrospective case note analysis of 100 patients with the lowest B12 levels over an 18 month period 1999-2001, collected from a database of 953 B12 deficient patients (<215 µg/I). Results: B12 levels ranged from 52 to 145 (median 128) µg/I. B12 levels correlated significantly with MCV (p < 0.001) but not with age (p = 0.54). Investigations were by the following groups: 35% general physicians, 24% gastroenterologists, 22% geriatricians, 4% haematologists, and 15% others (eg surgeons, obstetricians). 28% of Iow B12s were missed (mostly by the non-physician group 53%), 37% were investigated and treated, 22% were not investigated but just treated, and 8% were clinically diagnosed and treated. An age bias approach was taken to just treating without investigating (median age 82). The most common diagnosis was pernicious anaemia (n = 17) followed by surgical resection (gastrectomy n = 4, terminal ileum n = 4); coeliac disease was the cause in 2 patients. All Crohn's patients had had surgical resections. Schillings test had the best positive yield of 56%, while GPC and IF antibody testing had a yield of 39%. Conclusions and Recommendations: Too many Iow B12 levels are missed by all groups of doctors, but most noticeably by non-physicians. Laboratory alerts should therefore appear on results. A good history will often reveal the cause; if not, GPC, IF, gliadin, and endomysial antibodies should be the first line tests. A high MCV should always lead to checking a B12 level. Referral to gastroenterologists should occur when symptoms suggest a Gl cause.


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