Revised BC Guideline: Cobalamin (Vitamin B12) and Folate Deficiency
The Cobalamin (Vitamin B12) and Folate Deficiency guideline (effective 18 January 2023) covers the primary care investigation and management of cobalamin (vitamin B12 or simply B12) and folate deficiency in adults. This guideline outlines the indications for B12 testing and discusses an observed increase in B12 testing in BC.
- Outpatient and inpatient laboratory test volumes for B12 investigations increased from 267 721 to 570 265 between 2013 and 2020. This resulted in an increase in annual B12 testing expenditure from $3 million to $5.6 million during the same time period.
- On average, 420 303 tests cost $4.4 million per year.
- Patients ≥ 65 years of age accounted for the majority (37%) of B12 test volumes in 2019.
- Female patients account for 62% of annual test volumes while males account for 38%.
Key recommendations include:
- Routine B12 screening and testing in asymptomatic patients is not supported by evidence.
- Consider B12 supplementation without testing in asymptomatic patients with risk factors for B12 deficiency. Patients can call 8-1-1 to speak with a HealthLink BC registered dietitian.
- B12 deficiency can cause preventable permanent injury and should be considered with new onset neurological conditions and symptoms suggestive of B12 deficiency.
- Folate testing is rarely indicated but may be available via consultation with the laboratory medicine physician or scientist.
- Folate deficiency in pregnancy is associated with preventable and serious fetal harm (i.e., neural tube defects). Folic acid supplementation is recommended during pregnancy.
- A daily multivitamin containing B12 and folic acid is recommended for all people who could become pregnant, especially those with a vegan diet.
|This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.|
Martin Dawes, MD, Janet Evans, MD, Dan Holmes, MD, Andre Mattman, MD, Doug McTaggart, MD, Parin Patel, MD, Hetesh Ranchod, MD, Chase Simms, MPH. Revised BC Guideline: Cobalamin (Vitamin B12) and Folate Deficiency . BCMJ, Vol. 65, No. 4, May, 2023, Page(s) - News.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org