Don’t order vitamin B12 and Folate tests for tiredness: pathologists
Vitamin B12 and Folate don’t have overlapping risk factors and shouldn’t be tested together, particularly for non-specific symptoms such as tiredness, the Royal College of Pathologists has announced.
These new position statements provide context to recent changes to the Australian Medical Benefits Schedule.
“Testing for Vitamin B12 or Folate deficiencies in patients with non-specific symptoms, such as weakness and tiredness is not recommended,” Vice President Dr Michael Harrison said.
They say Vitamin B12 and Folate deficiencies should only be suspected in patients with:
- neuropsychiatric symptoms
- haematological disorders
- Type 1 diabetes
- malnourished and undernourished
- patients taking proton pump inhibitors long term.”
Dr Harrison also reminds doctors that although rare, severe untreated Vitamin B12 deficiency can lead to permanent neurological damage and maternal folate deficiency is linked to fetal neural tube defects.
The RCPA testing recommendations are:
Vitamin B12 Testing Protocol – Measure serum Total B12, and if this result is less than a laboratory determined sufficiency threshold, perform a holotranscobalamin level. Depending on the outcome of this test, a metabolite of a Vitamin B12-dependant metabolic pathway, for example, homocysteine or methyl malonic acid (MMA) may then be measured.
New Folate testing Protocol – Serum Folate level is the first line test with red blood cell (RBC) Folate estimation only to be performed when the serum value is low.
Read the full Vitamin B12 and Folate position statement.
New faecal pathogen screening recommendations
The College also announced new recommendations for faecal pathogen screening to try to lower over treatment and diagnosis of patients.
It recommended using a multiplex PCR without Dientamoeba fragilis and Blastocystis species when testing for faecal pathogens.
Dr Harsha Sheorey, spokesperson on faecal pathogens for the RCPA, said recent DNA-based diagnostic methods have determined that these organisms are much more common than first thought.
“The PCR techniques have led to unnecessary diagnoses and the over treatment of these two organisms. This results in needless anxiety amongst patients and parents and can even cause possible harm due to the disruption of the normal flora from the use of antibiotics as treatment.”
If a PCR is requested and a positive result is found, the report should highlight the questionable pathogenicity of these two organisms.
Read the full faecal pathogen position statement.