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CPE-009 · Context triggers
B12-11: Higher-risk group without B12 on file
Higher-risk group without B12 on file. Evaluates age 60 and over, vegan or vegetarian diet, bariatric surgery, ileal resection or Crohn disease, celiac disease, atrophic gastritis, heavy alcohol use or HIV.
Condition
- age 60 and over, vegan or vegetarian diet, bariatric surgery, ileal resection or Crohn disease, celiac disease, atrophic gastritis, heavy alcohol use or HIV
- vitamin B12 not measured
What it reports
- Screening opportunity: a group at higher risk of B12 deficiency has no measurement
Diagnostic boundary
- Groups raise the pre-test likelihood.
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-07
Macrocytosis in a patient with alcohol use disorder
MCV 104, B12 not measured.
B12-FX-12
A PPI for 30 months at age 72
Acid suppression and age.
B12-FX-14
Strict vegan diet
No B12 on file.
B12-FX-15
Bariatric surgery
No B12 on file.
B12-FX-24
Numb feet and unsteady, B12 never measured
Neurologic features without a level.
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