Journal
CLINICAL CHEMISTRY AND LABORATORY MEDICINE
Volume 51, Issue 3, Pages 489-496Publisher
WALTER DE GRUYTER GMBH
DOI: 10.1515/cclm-2012-0545
Keywords
cobalamin-binding proteins; diagnostic strategy; high plasma cobalamin; vitamin B12
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Funding
- Faculty of Health, Aarhus University
- Danish Medical Research Council
- Lundbeck Foundation
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It is well-established that more than 8% of patients examined for vitamin B12 deficiency unexpectedly have increased plasma levels of the vitamin, but so far there are no guidelines for the clinical interpretation of such findings. In this review, we summarise known associations between high plasma cobalamin and diseases. We report associations mainly with cancer, liver and kidney diseases, but also with a number of other diagnostic entities. The pathogenic background is poorly understood and is likely to be multi-factorial, involving increased concentrations of one or both of the circulating cobalamin binding proteins, transcobalamin and haptocorrin. Based on current knowledge, we suggest a strategy for the clinical interpretation of unexpected high plasma cobalamin. Since a number of the associated diseases are critical and life-threatening, the strategy promotes the concept of 'think the worst first'. It is important to realise that high cobalamin levels can be an unspecific marker for cancer. If this can be ruled out, diseases of the liver and kidney should be considered.
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