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CPE-009 · Safety
B12-04: Folic acid before B12 status is known
Folic acid before B12 status is known. Evaluates macrocytosis or anemia.
Active rulePriority 2B12 engine v1.0.0
Condition
- macrocytosis or anemia
- folic acid ordered or planned
- vitamin B12 not measured
What it reports
- Safety: correcting a megaloblastic anemia with folic acid alone can mask vitamin B12 deficiency while neurologic damage progresses
Recommended next steps (for physician review)
- Measure vitamin B12 before or together with any folic acid treatment
Diagnostic boundary
- A safety prompt, not a treatment instruction.
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-STABLER-2013Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-160.Supports: Clinical presentations, subacute combined degeneration, nitrous oxide and drug causes
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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