Screening for vitamin B_12 Deficiency: Caveat Emptor
Authors: Ralph Green
Journal: Annals of Internal Medicine (1996)

Editorials1 March 1996Screening for vitamin B12 Deficiency: Caveat EmptorRalph Green, MDRalph Green, MDThe Cleveland Clinic Foundation, Cleveland, OH 44195Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-5-199603010-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Gastrectomy provides a surgical paradigm for pernicious anemia; the scalpel and autoantibodies both disrupt the crucial gastric component of cobalamin (vitamin B12) absorption. That patients are at risk for developing cobalamin deficiency after gastrectomy is therefore obvious and known. The time from surgery to the onset of cobalamin deficiency varies with the extent of parietal cell ablation and with the inventory of the stored vitamin that is conserved and stockpiled during times of plenty. In this issue, Sumner and colleagues [1] report the results of follow-up screening for cobalamin deficiency in a large series of patients who have had gastrectomy. ...References1. Sumner AE, Chin MM, Abrahm JL, Berry GT, Gracely EJ, Allen RH, et al. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Ann Intern Med. 1996; 124:469-76. Google Scholar2. Hines JD, Hoffbrand AV, Mollin DL. The hematologic complications following partial gastrectomy. A study of 292 patients. Am J Med. 1967; 43:555-69. Google Scholar3. Green R. Metabolite assays in cobalamin and folate deficiency. In: Wickramasinghe SN, ed. Megaloblastic Anaemias: Baillieres Clin Haematol. 1995; 8:533-66. Google Scholar4. Jacob E, Baker SJ, Herbert V. Vitamin B12-binding proteins. Physiol Rev. 1980; 60:918-60. Google Scholar5. Hakami N, Neiman PE, Canellos GP, Lazerson J. Neonatal megaloblastic anemia due to inherited transcobalamin II deficiency in two siblings. N Engl J Med. 1971; 285:1163-70. Google Scholar6. Corcino JJ, Zalusky R, Greenberg M, Herbert V. Coexistence of pernicious anaemia and chronic myeloid leukaemia: an experiment of nature involving vitamin B12 metabolism. Br J Haematol. 1971; 20:511-20. Google Scholar7. Green R. Typical and atypical manifestations of pernicious anemia. In: Besser M, Bhatt R, James VH, Keen H, eds. Thomas Addison and His Diseases: 200 Years On. J Endocrinol. 1994; 1Sup:377-90. Google Scholar8. Herzlich B, Herbert V. Depletion of serum holotranscobalamin II. An early sign of negative vitamin B12 balance. Lab Invest. 1988; 58:332-7. Google Scholar9. Goh YT, Jacobsen DW, Green R. Diagnosis of functional cobalamin deficiency: utility of transcobalamin-bound vitamin B12 determination in conjunction with total serum homocysteine and methylmalonic acid [Abstract]. Blood. 1991; 78:(Suppl 1):100a. Google Scholar10. Allen RH, Stabler SP, Savage DG, Lindenbaum J. Diagnosis of cobalamin deficiency I: usefulness of serum methylmalonic acid and total homocysteine concentrations. Am J Hematol. 1990; 34:90-8. Google Scholar11. Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med. 1994; 96:239-46. Google Scholar12. Schilling RF. Who has vitamin B12 deficiency? Proceedings of the Association of American Physicians. 1996; [In press]. Google Scholar13. Norman EJ, Martelo OJ, Denton MD. Cobalamin (vitamin B12) deficiency detection by urinary methylmalonic acid quantitation. Blood. 1982; 59:1128-31. Google Scholar14. Chanarin I. The Megaloblastic Anaemias. 2d ed. Oxford: Blackwell Scientific; 1979. Google Scholar15. Lindenbaum J, Savage DG, Stabler SP, Allen RH. Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid and total homocysteine concentrations. Am J Hematol. 1990; 34:99-107. Google Scholar16. Carmel R. Subtle cobalamin deficiency [Editorial]. Ann Intern Med. 1996; 124:338-40. Google Scholar17. Spivak JL. Masked megaloblastic anemia. Arch Intern Med. 1982; 142:2111-4. Google Scholar18. Pennypacker LC, Allen RH, Kelly JP, Matthews LM, Grigsby J, Kaye K, et al. High prevalence of cobalamin deficiency in elderly outpatients. J Am Geriatr Soc. 1992; 40:1197-204. Google Scholar19. Naurath HJ, Joosten E, Riezler R, Stabler SP, Allen RH, Lindenbaum J. Effects of vitamin B12, folate, and vitamin B6 supplements in elderly people with normal serum vitamin concentrations. Lancet. 1995; 346:85-9. Google Scholar Author, Article, and Disclosure InformationAffiliations: The Cleveland Clinic Foundation, Cleveland, OH 44195Corresponding Author: Ralph Green, MD, Section of Hematology (FF4), The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoElevated Methylmalonic Acid and Total Homocysteine Levels Show High Prevalence of Vitamin B12 Deficiency after Gastric Surgery Anne E. Sumner , Margaret M. Chin , Janet L. Abrahm , Gerard T. Berry , Edward J. Gracely , Robert H. Allen , and Sally P. Stabler Metrics Cited byPrevalence of low serum vitamin B12 in Mexican children and women: results from the first National Nutrition Survey (1999) as a basis for interventions and progressVitamin B12 Replasman Tedavisi; Oral? 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