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Serum methylmalonic acid and total homocysteine in patients with suspected cobalamin deficiency: A clinical study based on gastrointestinal histopathological findings
Author(s) -
Lindgren Anders,
Swolin Birgitta,
Nilsson Ola,
Johansson Kurt W.,
Kilander Anders F.
Publication year - 1997
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/(sici)1096-8652(199712)56:4<230::aid-ajh6>3.0.co;2-y
Subject(s) - cobalamin , methylmalonic acid , homocysteine , medicine , gastroenterology , folic acid , vitamin b12
We compared the sensitivity and specificity of the two metabolite tests, methylmalonic acid (MMA) and total homocysteine (Hcy) in serum, and serum cobalamin (Cbl) in patients referred to our hospital because of suspected cobalamin deficiency and a serum cobalamin value at the referring unit <200 pmol/L. All 111 patients included were investigated using upper gastrointestinal endoscopy with biopsy specimens taken from the gastric and duodenal mucosa to find a morphological basis for cobalamin malabsorption as well as the Schilling test for the validation of the serum tests. All patients were treated with cobalamin and new blood samples were taken after 4 weeks. We found no difference in sensitivity and specificity between serum MMA, Hcy, and Cbl in identifying patients with and without conditions compatible with cobalamin malabsorption. Elevated serum MMA and Hcy were also found in about 15% of the group of patients with normal Schilling tests and without a morphological basis for cobalamin malabsorption. Moreover, most patients in this group responded with decreased values of the metabolite tests following cobalamin treatment, suggesting that neither elevated metabolites nor a decrease in these values following cobalamin treatment are specific for cobalamin deficiency. Am. J. Hematol. 56:230–238, 1997. © 1997 Wiley‐Liss, Inc.