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CPE-009 · Classification
B12-02: Borderline B12 with raised MMA or homocysteine
Borderline B12 with raised MMA or homocysteine. Evaluates serum vitamin B12 200 to 300 pg/mL.
Active rulePriority 3B12 engine v1.0.0
Condition
- serum vitamin B12 200 to 300 pg/mL
- methylmalonic acid > 0.27 µmol/L OR homocysteine > 15 µmol/L
What it reports
- Functional vitamin B12 deficiency pattern: tissue deficiency despite a serum value that looks acceptable
Diagnostic boundary
- Renal impairment raises MMA and homocysteine; interpret with eGFR.
Evidence
- EV-BSH-2014Devalia 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.Supports: Diagnostic approach with serum B12, MMA and homocysteine Neurologic involvement means treatment should not wait for confirmation Folic acid alone must not be given while B12 deficiency is unexcluded
- EV-GREEN-2017Green R, Allen LH, Bjørke-Monsen AL, et al. Vitamin B12 deficiency. Nat Rev Dis Primers. 2017;3:17040.Supports: Functional deficiency, markers (MMA, homocysteine) and causes including autoimmune gastritis
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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