I keep browsing the CPD/CME comments section of the BMJ article and came up with this comment:
"I have never worked in an area with access to homocysteine or methymalonic acid assays - ? this is unusual, or not. If not unusual what is the relevance of their discussion in a BMJ clinical review ? better focusing on how to practice with the imperfections of the standard B12 test"
That comment is from a haematologist (inc transfusions)
Now, what do the NICE and BNF guidelines say again about referring patients to haematologists? Because the above comment indicates to me that they aren't quite getting it?
I'm just wondering how this particular clinician is going to 'practice' with the current imperfections - rather than simply get patients additional tests that may confirm a diagnosis.
Right. Had a coffee now I'm up for a rant.
The whole research paper revolves around the metabolic pathways and the reasons the serum b12 test is unreliable and gives alternatives to the test so they can pick up patients suffering neurological degeneration who are not getting treatment.
And this pleb comes along and says what is the point in mentioning the alternative tests?
Can we take it that he didn't score very highly in the test he elected to take?
So, he wants to 'practice' with the serum b12, does he?
Here's the alternative research paper.
DNA changes in the spinal cord fluid indicate the deficient levels of the serum b12 test should come into play at around 500ng.