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Table 5: Tailored Diagnostic Approach for Vitamin B12 Deficiency.

ProblemGoalSuggested Tests
Patient with mild to severe hematologic or neurologic signs or symptoms, or bothConfirm suspected vitamin B12 deficiencySerum B12

Patient with hematologic or neurologic signs or symptoms, or both, unlikely due to vitamin B12 deficiency

Ensure if vitamin B12 deficiency exists, it is not missedSerum B12 MMA* and HCY†
Asymptomatic patient with condition known to cause vitamin B12 deficiencyDetermine if vitamin B12 deficiency has developed yetMMA (metablic changes often precede low cobalamin levels)
Asymptomatic patient accidentally found to have low B12 level or high Hcy†Determine if vitamin B12 deficiency existsMMA

*MMA - methylmalonic acid

†Hcy-homocysteine

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