Often a common condition for vegetarians and vegans, severe vitamin B12 deficiency can result in serious complications if undiagnosed or untreated. Vitamin B12 is vital for appropriate red blood cell formation, neurological function, and DNA and RNA synthesis. Vitamin B12 deficiency is a silent and under-diagnosed condition. Laboratory strategies can improve detection of new cases and their treatment.
By Maria Salinas
Severe vitamin B12 deficiency can result in serious complications if undiagnosed or left untreated. It is associated with cognitive decline and dementia, and may lead to DNA damage and altered methylation, both important risk factors for cancer.
Older subjects are at the highest risk for vitamin B12 deficiency and commonly used treatments in primary care suppress the production of gastric acid and thus may lead to malabsorption of vitamin B12.
Easy, affordable treatment
In all, it is critical to identify and treat patients, given the major adverse effects and potential irreversible cognitive damage of this condition, the low economic cost and lack of toxicity of vitamin B12 treatment and the technically easy and inexpensive way to detect it through the measurement of serum vitamin B12 (s-vitamin B12).
Clinical laboratory strategies
In their study published in the journal Clinical Chemistry and Laboratory Medicine, the authors proposed two different interventions to improve the detection and treatment of new cases of severe vitamin B12 deficit.
To improve the detection, the Laboratory Information System automatically added s-vitamin B12 to the laboratory request of any primary care patient whose erythrocyte mean corpuscular volume was high, when the former was not requested either in the current order or in the previous year.
Regarding the treatment intervention, when a new case of severe vitamin B12 deficit was identified, three actions were taken: a comment was added in the laboratory report (“Vitamin B12 therapy is recommended”) and a patient appointment with the General Practitioner (GP) was created in the Electronical Medical Record. Additionally, a report was printed on garish colour paper and shipped to the requesting GP to further alert him about the need of action.
Impact of strategies
Through the automatic register of s-vitamin B12, a new case of severe vitamin B12 deficit was detected for every 10 measured tests. The strategy also dramatically improved patient management; most s-vitamin B12 results of new cases of severe vitamin B12 deficit were correctly interpreted and acted upon, and, as such, patients treated correctly.
Laboratory strategies positively impacted patient outcome by identifying subjects with severe vitamin B12 deficiency that would have otherwise remained undiagnosed, and by improving effective clinical management.
Read the original article for free here:
Maria Salinas, Emilio Flores, Maite López-Garrigós, Maria Leiva-Salinas, Alberto Asencio, Javier Lugo, Carlos Leiva-Salinas: Computer-assisted interventions in the clinical laboratory process improve the diagnosis and treatment of severe vitamin B12 deficiency. 1.05.2018