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CPE-009 · synthetic case B12-FX-24
Numb feet and unsteady, B12 never measured
Neurologic features without a level.
Purpose: Neurologic features without a level.
Inputs the engine received
Patient
- Age
- 69 years
- Sex
- Male
Neurologic features
- Peripheral neuropathy symptoms
- Yes
- Balance problems
- Yes
What the engine reports
Neurologic involvement can occur without anemia and raises the urgency of finding vitamin B12 deficiency. BSH advises that treatment should not wait for confirmation when neurologic involvement is present.
Detected clinical pattern
Neurologic Features — B12 Needed
Neurologic involvement can occur without anemia. A vitamin B12 level should not be overlooked.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Measure B12 (with MMA) promptly.BSH 2014.
- 2Consider a vitamin B12 measurement.
Missing information
- Vitamin B12 level.
Evidence and rule trace · 3 rules
B12-05Neurologic or psychiatric features with unmeasured or low B12
Inputs: neuropathy symptoms · balance problems · B12 not measured
Neurologic involvement raises the urgency of finding B12 deficiency.
B12-11Higher-risk group without B12 on file
Inputs: age 60 or over
Screening opportunity: a higher-risk group has no B12 measurement.
Evidence
- EV-BSH-2014 · Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.
- EV-STABLER-2013 · Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-160.
- EV-GREEN-2017 · Green R, Allen LH, Bjørke-Monsen AL, et al. Vitamin B12 deficiency. Nat Rev Dis Primers. 2017;3:17040.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety considerations. It does not diagnose, find the cause, or select a vitamin product, dose or route. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Serum B12 level
○ Below 200 pg/mL
Deficiency pattern
○ 200 to 300 pg/mL
Borderline: MMA and homocysteine settle it
○ Above 300 pg/mL
Deficiency unlikely, not excluded
No stage is assigned for the values entered.
Laboratory
- <200
- 200–300
- >300
Patient
Neurologic features
Drugs, diet and risk groups
More b12 cases
B12-FX-01
B12 of 150 pg/mL with macrocytic anemia
A 67-year-old with MCV 108.
B12-FX-02
Borderline B12 with raised MMA
B12 260 and MMA 0.52.
B12-FX-03
Borderline B12 and no confirmatory test
B12 250.
B12-FX-04
Macrocytic anemia, folic acid ordered, no B12
A safety situation.
B12-FX-05
Neuropathy, B12 220 and metformin for five years
Neurologic features with a borderline level.
B12-FX-06
Posterior-column signs and spasticity
A pattern compatible with subacute combined degeneration.
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