Serum vitamin B12

Serum vitamin B₁₂ is a medical laboratory test that measure vitamin B₁₂ only in the blood binding to both transcobalamins.[1] Most of the time, 80–94% of vitamin B₁₂ in the blood binds to haptocorrin, while only 6–20% is binds to transcobalamin ll.[2] Only transcobalamin ll is "active" and can be used by the body.[1] Normal total body vitamin B₁₂ is between 2 and 5 mg with 50% of that stored in the liver.[3] Total serum vitamin B₁₂ may not be a reliable biomarker for reflecting what the body stores inside cells.[1] Vitamin B₁₂ levels can be falsely high or low and data for sensitivity and specificity vary widely. There is no gold standard human assay to confirm a vitamin B₁₂ deficiency.[4]

Healthcare providers use this test when a vitamin B₁₂ deficiency is suspected, which can cause anemia and irreversible nerve damage.[3] The cutoff between normal vitamin B₁₂ levels and deficiency varies by country and region.[3] A diagnosis of vitamin B₁₂ deficiency is determined by blood levels lower than 200 or 250 picograms per ml (148 or 185 picomoles per liter).[3] Other tests may be done to ensure individuals status.[3] Measuring vitamin B₁₂ values in individuals during or after treatment, in order to measure the effectiveness of treatment, is useless.[5]

Normal range

A blood test shows vitamin B₁₂ levels in the blood.[3] Vitamin B₁₂ deficiency can be determined, but not always.[4] This means it measures forms of vitamin B₁₂ that are "active" and can be used by the body, as well as the "inactive" forms, which cannot.[6] However, also normal or supraphysiological vitamin B₁₂ levels should be carefully assessed in the context of the individual state of health.[1] Elevated or normal serum vitamin B₁₂ levels may also be associated with a functional vitamin deficiency.[1] Functional deficiency has been described despite high B₁₂ concentrations and is due to a failure of cellular uptake, intracellular processing, trafficking, or utilization.[1] However, low vitamin B₁₂ levels may occur other than the true deficiency for various reasons and circumstances.[7] High or supraphysiological serum levels are usually not of concern, although without supplementation they have been associated with many pathological conditions.[1]

Reference range for vitamin B₁₂:
- 200 to 1000 picograms per ml (148 to 748 picomoles per liter)

Laboratories often use different units and "normal" may vary by population and the lab techniques used. Some researchers have suggested that current standards for vitamin B₁₂ levels are too low.[8]

References

Vollbracht, C; McGregor, G P; Kraft, K (2019-06-28). "Supraphysiological vitamin B12 serum concentrations without supplementation: the pitfalls of interpretation". QJM: An International Journal of Medicine. 113 (9): 619–620. doi:10.1093/qjmed/hcz164. ISSN 1460-2725. PMC 7550708. PMID 31251363.
Sugihara, Takaaki; Koda, Masahiko; Okamoto, Toshiaki; Miyoshi, Kenichi; Matono, Tomomitsu; Oyama, Kenji; Hosho, Keiko; Okano, Jun-ichi; Isomoto, Hajime; Murawaki, Yoshikazu (2017-03-09). "Falsely Elevated Serum Vitamin B12 Levels Were Associated with the Severity and Prognosis of Chronic Viral Liver Disease". Yonago Acta Medica. 60 (1): 31–39. ISSN 0513-5710. PMC 5355842. PMID 28331419.
"Office of Dietary Supplements - Vitamin B12". ods.od.nih.gov. Retrieved 2023-10-14.
Herbert, V.; Colman, N.; Palat, D.; Manusselis, C.; Drivas, G.; Block, E.; Akerkar, A.; Weaver, D.; Frenkel, E. (November 1984). "Is there a "gold standard" for human serum vitamin B12 assay?". The Journal of Laboratory and Clinical Medicine. 104 (5): 829–841. ISSN 0022-2143. PMID 6387014.
"Diagnosis and treatment pitfalls – B12 institute". Retrieved 2023-10-14.
"Vitamin B12 or folate deficiency anaemia - Diagnosis". nhs.uk. 2017-10-20. Retrieved 2023-10-14.
Snow, C. F. (1999-06-28). "Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician". Archives of Internal Medicine. 159 (12): 1289–1298. doi:10.1001/archinte.159.12.1289. ISSN 0003-9926. PMID 10386505.
Goodman, Mark; Chen, X. Helen (October 1996). "ARE U.S. LOWER NORMAL B 12 LIMITS TOO LOW?". Journal of the American Geriatrics Society. 44 (10): 1274–1275. doi:10.1111/j.1532-5415.1996.tb01389.x.

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[:0-1] Vollbracht, C; McGregor, G P; Kraft, K (2019-06-28). "Supraphysiological vitamin B12 serum concentrations without supplementation: the pitfalls of interpretation". QJM: An International Journal of Medicine. 113 (9): 619–620. doi:10.1093/qjmed/hcz164. ISSN 1460-2725. PMC 7550708. PMID 31251363.

[2] Sugihara, Takaaki; Koda, Masahiko; Okamoto, Toshiaki; Miyoshi, Kenichi; Matono, Tomomitsu; Oyama, Kenji; Hosho, Keiko; Okano, Jun-ichi; Isomoto, Hajime; Murawaki, Yoshikazu (2017-03-09). "Falsely Elevated Serum Vitamin B12 Levels Were Associated with the Severity and Prognosis of Chronic Viral Liver Disease". Yonago Acta Medica. 60 (1): 31–39. ISSN 0513-5710. PMC 5355842. PMID 28331419.

[:1-3] "Office of Dietary Supplements - Vitamin B12". ods.od.nih.gov. Retrieved 2023-10-14.

[:2-4] Herbert, V.; Colman, N.; Palat, D.; Manusselis, C.; Drivas, G.; Block, E.; Akerkar, A.; Weaver, D.; Frenkel, E. (November 1984). "Is there a "gold standard" for human serum vitamin B12 assay?". The Journal of Laboratory and Clinical Medicine. 104 (5): 829–841. ISSN 0022-2143. PMID 6387014.

[5] "Diagnosis and treatment pitfalls – B12 institute". Retrieved 2023-10-14.

[6] "Vitamin B12 or folate deficiency anaemia - Diagnosis". nhs.uk. 2017-10-20. Retrieved 2023-10-14.

[7] Snow, C. F. (1999-06-28). "Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician". Archives of Internal Medicine. 159 (12): 1289–1298. doi:10.1001/archinte.159.12.1289. ISSN 0003-9926. PMID 10386505.

[8] Goodman, Mark; Chen, X. Helen (October 1996). "ARE U.S. LOWER NORMAL B 12 LIMITS TOO LOW?". Journal of the American Geriatrics Society. 44 (10): 1274–1275. doi:10.1111/j.1532-5415.1996.tb01389.x.