Thanks very much for that, Sleepybunny - very interesting.
"Normal cobalamin serum levels do NOT rule out a cobalamin deficiency" - great to have in writing. Also citing "diarrhoea" as a symptom. No macrocytosis present either.
These could all be of use to people trying to get GP's help.
So a few points ringing bells but some alarm-bells ringing too:
I think this guy knew he was in trouble previously and was ignored-
"....especially no gastrointestinal, haematological or psychiatric disorders were proveable."
(not "present") and "Furthermore, a subacute progress of disease was reported by the patient....." in the conclusion.
It would be even more interesting if there was some input about that journey from the patient's perspective and a follow-up with him regarding long-term treatment and efficacy, don't you think ?
Interesting, for instance, that he got quite a bit of (late?) improvement and how long it took, and MMA returned to bang in the middle of range but that gastrin level still very high at 730 pg/ml (range: 13-115pg/ml) at 11 months on.
I can see also why my MMA results, at a stubborn but paltry 350-400nmol/L , are ignored as unimportant. His were a whopping 40,800 !!!! (Range: circa 0-280 nmol/L)
Also interesting that at this stage, he could not feel the difference between a pen and a rolled-up bandage- no wonder he fell off a roof.
I'm also unsure that "Lowered serum HoloTC is the earliest marker of cobalamin deficiency and reduced even before any clinical symptoms apparent" (Hermann W et al) is as reliable a first indicator as you can get.
I'm sure I have seen evidence pointing elsewhere for that - what do you think ?
"I'm also unsure that "Lowered serum HoloTC is the earliest marker of cobalamin deficiency and reduced even before any clinical symptoms apparent" (Hermann W et al) is as reliable a first indicator as you can get. "
I have the same reservation as you over this comment. I don't think any of tests used to help diagnose b12 deficiency eg serum B12. Active B12 (HoloTC), MMA and homocysteine are infallible.
This flowchart suggests that doctors should continue B12 treatment if patient has responded to treatment even if second line tests such as Active B12, MMA and homocysteine are normal range.
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