Michael Heaton
Haematology and Blood Transfusion Services Manager
RoyalOldhamHospital
Rochdale Road
Oldham
OL1 2JH
Tel 0161 6561678
Internal extension 71678
Email:
15thFebruary 2018
Dear Colleague
Re: Vitamin B12 testing in the North East Sector CCG
The Haematology laboratory at the Pennine Acute Hospitals NHS Trust has seen a substantial increase in the number of Vitamin B12 test requests over the last 3 years. The numbers have increased by approximately 25-30% to a figure in the order of 200,000 requests per annum; the majority of which are requested by General Practitioners.
There is no direct evidence regarding the clinical utility of routine vitamin B12 screening in the general population. While, most clinical practice guidelines either advocate or recommend against routine screening for vitamin B12, others recommend vitamin B12 testingin patients with symptoms of vitamin B12 deficiency, such as macrocytic anaemia or macrocytosis and patients with suspected neuropsychiatric abnormalities, such as dementia. Other populations where testing could be considered include the elderly, long term vegans, people on drugs that interfere with vitamin absorption such as H2 receptor antagonists or proton pump inhibitors or Metformin. Patients with inflammatory bowel disease, gastric or small intestine resection mayalso be considered for vitamin B12 testing.
There is norecommendation on the frequency of vitamin B12 testing; however,if specific clinical situations require follow up re-testing, the interval should be between six to twelve months.
This letter and attached guidelines seeks to provide support and advice on appropriate testing for serum Vitamin B12. For further clinical advice, please contact one of the Consultant Haematologists. In addition, a representative from the clinical haematology team would be happy to visit General Practitioners to discuss vitamin B12 testing and the consequent clinical management of B12 deficiency.
Yours sincerely
Michael Heaton
Haematology and Blood Transfusion Services Manager
Acute Pennine Hospitals NHS Trust