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The pathophysiology of elevated vitamin B12 in clinical practice.

Abstract

Hypercobalaminemia (high serum vitamin B12 levels) is a frequent and underestimated anomaly. Clinically, it can be paradoxically accompanied by signs of deficiency, reflecting a functional deficiency linked to qualitative abnormalities, which are related to defects in tissue uptake and action of vitamin B12. The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. These entities are essentially comprised of solid neoplasms, haematological malignancies and liver and kidney diseases. This review reflects the potential importance of the vitamin B12 assay as an early diagnostic marker of these diseases. A codified approach is needed to determine the potential indications of a search for high serum cobalamin and the practical clinical strategy to adopt upon discovery of elevated cobalamin levels. While low serum cobalamin levels do not necessarily imply deficiency, an abnormally high serum cobalamin level forms a warning sign requiring exclusion of a number of serious underlying pathologies. Functional cobalamin deficiency can thus occur at any serum level.

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  • Publisher Full Text
  • Authors

    Andrès E, Serraj K, Zhu J, Vermorken AJ

    Source

    QJM : monthly journal of the Association of Physicians 106:6 2013 Jun pg 505-15

    MeSH

    Biological Markers
    Hematologic Diseases
    Humans
    Liver Diseases
    Neoplasms
    Transcobalamins
    Tumor Markers, Biological
    Vitamin B 12
    Vitamin B 12 Deficiency

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    23447660