B12, folate testing not routine screening: RCPA

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Today, the Royal College of Pathologists of Australasia has announced a new position statement clarifying the use and interpretation of Vitamin B12 and Folate testing for diagnosing and monitoring deficiency.

The RCPA’s position statement provides guidance to clinicians in the context of the recent changes to the relevant items in the Australian Medical Benefits Schedule.

Dr Michael Harrison, Vice President of the RCPA, says that B12 and Folate tests are not conducted as routine screening.

“We recommend that Vitamin B12 and Folate deficiencies should only be suspected in patients with neuropsychiatric symptoms, haematological disorders, malabsorption, Type 1 diabetes, in the malnourished and undernourished, or patients taking proton pump inhibitors long term.

“Testing for Vitamin B12 or Folate deficiencies in patients with non-specific symptoms, such as weakness and tiredness is not recommended.  As risk factors for Vitamin B12 and Folate deficiency do not generally overlap, levels should not be routinely requested together – except in suspected malabsorption,” says Dr Harrison.

However, Dr Harrison also highlights uncommon cases of deficiency.

“Although rare, severe untreated Vitamin B12 deficiency can lead to permanent neurological damage and maternal folate deficiency is linked to fetal neural tube defects.

“Many Vitamin B12 or Folate deficient patients have no clinical signs and the Full Blood Count (FBC) is often normal, including normal Haemoglobin levels and a normal Mean Corpuscular Volume,” says Dr Harrison.

Follow up testing should only occur in the presence of haematological abnormalities, via a Full Blood Count (FBC)/reticulocyte count at one week and one month to confirm normalisation of counts.

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