Indian Journal of Medical Biochemistry

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VOLUME 24 , ISSUE 1 ( January-April, 2020 ) > List of Articles

Original Article

Comparison of Diagnostic Accuracy of Active B12 (Holotranscobalamin) and Total Vitamin B12 (Cobalamin) and Verification of Active B12 Test

Poonam M Pal

Citation Information : Pal PM. Comparison of Diagnostic Accuracy of Active B12 (Holotranscobalamin) and Total Vitamin B12 (Cobalamin) and Verification of Active B12 Test. Indian J Med Biochem 2020; 24 (1):25-31.

DOI: 10.5005/jp-journals-10054-0133

License: CC BY-NC 4.0

Published Online: 03-11-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Objective: This study is based on the comparison of the diagnostic accuracy of active B12 (holotranscobalamin) to total vitamin B12 (cobalamin) and verification of the active B12 test for clinical use. Materials and methods: We have considered 310 individuals (total, mean age 48 ± 15years) that includes 233 individuals with serum active B12 levels within the biological reference interval of 20.6–196.7 pmol/L (controls, mean age 47 ± 15 years) and 54 individuals with serum active B12 levels below 20.6 pmol/L (cases, mean age 46 ± 13 years). Results: Based on the study, we have found that the diagnostic accuracy of active B12 (holotranscobalamin) was found to be better than that of total vitamin B12 (cobalamin). The precision of active B12 testing was found to be comparable to the manufacturer's claim. The reference interval for active B12 was also found to be comparable to the manufacturer's claim. Conclusion: From the above study, active B12 assay was found to be a better means for detecting vitamin B12 deficiency in individuals, and also, this assay was found to be a better one to follow-up the vitamin B12 levels in the patients who are already vitamin B12-deficient. Clinical significance: Active B12 (holotranscobalamin) testing can be used as a secondary choice of test for the patients with total B12 levels within the gray-zone (100–400 pg/mL) or can be used as a primary choice of test for the diagnosis of vitamin B12 deficiency and the follow-up during its treatment.

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  1. Valente E, Scott JM, Ueland PM, et al. Diagnostic accuracy of holotranscobalamin, methylmalonic acid, serum cobalamin, and other indicators of tissue vitamin B12 status in the elderly. Clin Chem 2011;57(6):856–863. DOI: 10.1373/clinchem.2010.158154.
  2. Hvas AM, Nexo E, Diagnosis and treatment of Vitamin B12 deficiency–an, 2006.
  3. Herrmann W. Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am J Clin Nutrit 2003;78(1):131–136. DOI: 10.1093/ajcn/78.1.131.
  4. Herbert V. Staging vitamin status in vegetarians. Am J Clin Nutrit 1994;59:1213. DOI: 10.1093/ajcn/59.5.1213S.
  5. Herrmann W, Obeid R, Schorr H, et al. The usefulness of holotranscobalamin in predicting vitamin B12 status in different clinical settings. Curr Drug-Metabol 2005;6(1):47–53. DOI: 10.2174/1389200052997384.
  6. Lee YK, Kim HS, Kang HJ. Holotranscobalamin as an indicator of vitamin B12 deficiency in gastrectomized patients. Ann Clin Lab Sci 2009;39(4):361–366.
  7. Snow CF. Diagnosis of vitamin B 12 and folate deficiency. Arch Intern Med 2006.
  8. Chararin I. Megaloblastic anemia, cobalamin and folate. J Clin Pathol 1987;40(9):978–984. DOI: 10.1136/jcp.40.9.978.
  9. Aggarwal A, Wood I. Low vitamin B12 syndrome in trigeminal neuralgia. J Pain 2012;1(5):1–4. DOI: 10.4172/2167-0846.1000109.
  10. Lai SC, Nakayama Y, Sequeira JM, et al. The transcobalamin receptor knockout mouse: a model for vitamin B12 deficiency in the central nervous system. FASEB J 2013;27(6):2468–2475. DOI: 10.1096/fj.12-219055.
  11. Abdulmanea AA, Alsaeed AH, Shaik AP, et al. Pernicious anemia in patients with macrocytic anemia in patients with macrocytic anemia and low serum B12. J Med Sci 2014;30(6):1218–1222.
  12. Vira HJ, Importance of assessing total vitamin B12 and active B12 levels in cancer patients. 2018.
  13. Nexo E, Hvas AM. Holotranscobalamin-first choice assay for diagnosing early vitamin B12 deficiency. J Intern Med Suppl 2005;257(3):289–298. DOI: 10.1111/j.1365-2796.2004.01437.x.
  14. Sugihara T, Koda M, Okamoto T, et al. Falsely elevated serum vitamin B12 levels were associated with the severity and prognosis of chronic viral liver disease. Yonago Acta Med 2017;60(1):31–39.
  15. Golding PH. Holotranscobalamin (HoloTC, Active-B12) and Herbert's model for the development of vitamin B12 deficiency: a review and alternative hypothesis. Springerplus 2016;5(1):668. DOI: 10.1186/s40064-016-2252-z.
  16. Nexo E, Hoffmann-Lücke E. Holotranscobalamin, a marker of vitamin B-12 status: analytical aspects and clinical utility. Am J Clin Nutrit 2011;1(5):1–7. DOI: 10.3945/ajcn.111.013458.
  17. Al Aisari F, Al-Hashmi H, Mula-Abed W-A. Comparison between serum holotranscobalamin and total vitamin B12 as indicators of vitamin B12 status. Oman Med J 2010;1:9–12.
  18. Ulleland M, Eilertsen I, Quadros EV, et al. Direct assay for cobalamin bound to transcobalamin (holo-transcobalamin) in serum. Clin Chem 2002;48(3):526–532. DOI: 10.1093/clinchem/48.3.526.
  19. Bagge E, Nexo E, Lindgren A, et al. Holotranscobalamin-a sensitive marker of cobalamin malabsorption. Eur J Clin Invest 1999;29(4): 321–329. DOI: 10.1046/j.1365-2362.1999.00446.x.
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