Cobalamin deficiency in general practice. assessment of the diagnostic utility and cost-benefit analysis of methylmalonic acid determination in relation to current diagnostic strategies

Diagnosing cobalamin deficiency is often difficult. We investigated the diagnostic strategies that 224 general practitioners used to assess cobalamin status and the criteria on which they based their decisions to supplement patients. From all serum cobalamin analyses carried out at a single laborato...

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Bibliographic Details
Published in:Clinical chemistry (Baltimore, Md.) Md.), 1999-02, Vol.45 (2), p.189-198
Main Authors: HØLLELAND, G, SCHNEEDE, J, UELAND, P. M, LUND, P. K, REFSUM, H, SANDBERG, S
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Child
Child, Preschool
Cohort Studies
Cost-Benefit Analysis
Family Practice
Female
Folic Acid - blood
Homocysteine - blood
Humans
Infant
Male
Medical sciences
Metabolic diseases
Methylmalonic Acid - blood
Middle Aged
Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...)
Practice Patterns, Physicians
Reference Standards
Retrospective Studies
Vitamin B 12 - administration & dosage
Vitamin B 12 - blood
Vitamin B 12 Deficiency - blood
Vitamin B 12 Deficiency - diagnosis
Vitamin B 12 Deficiency - physiopathology
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Summary:Diagnosing cobalamin deficiency is often difficult. We investigated the diagnostic strategies that 224 general practitioners used to assess cobalamin status and the criteria on which they based their decisions to supplement patients. From all serum cobalamin analyses carried out at a single laboratory during 1993, individuals with serum cobalamin concentrations 0.376 micromol/L were used as the "reference standard" for cobalamin deficiency, the serum cobalamin assay had a diagnostic sensitivity of 0.40 and a specificity of 0.98. With the same reference standard, the diagnostic accuracy of the physicians' decision to supplement patients had the same specificity but a higher sensitivity (0.51). Cost-benefit analysis indicated that measurement of s-MMA can be recommended in patients with serum cobalamin >60-90 pmol/L and
ISSN:0009-9147
1530-8561
DOI:10.1093/clinchem/45.2.189