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CPE-009 · Classification
B12-08: Pernicious anemia evaluation
Pernicious anemia evaluation. Evaluates low or borderline B12.
Condition
- low or borderline B12
- age 60 and over, OR autoimmune disease (type 1 diabetes, autoimmune thyroid disease, vitiligo, Addison disease), OR glossitis
What it reports
- Autoimmune gastritis (pernicious anemia) is a leading cause: intrinsic-factor antibodies are specific when positive
Recommended next steps (for physician review)
- Consider intrinsic-factor antibodies
- If positive, pernicious anemia is supported and its gastric implications should be considered by the physician
Diagnostic boundary
- Negative antibodies do not exclude pernicious anemia.
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.
B12-FX-01
B12 of 150 pg/mL with macrocytic anemia
A 67-year-old with MCV 108.
B12-FX-05
Neuropathy, B12 220 and metformin for five years
Neurologic features with a borderline level.
B12-FX-08
Low B12 in a 71-year-old with autoimmune thyroid disease and glossitis
Intrinsic-factor antibodies not done.
B12-FX-09
Intrinsic-factor antibodies positive
Pernicious anemia is supported.
B12-FX-18
Low B12 and low folate
Both are deficient.
B12-FX-21
Schistocytes with raised LDH in a macrocytic anemia
Hemolytic features.
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