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Conditions include alcoholic liver disease, viral hepatitis, cirrhosis, and primary or metastatic liver cancer Renal dysfunction : Impaired kidney function reduces B12 elimination, causing accumulation even with normal intake Haematological conditions : Myeloproliferative neoplasms, chronic myeloid leukaemia, polycythaemia vera, and hypereosinophilic syndrome increase transcobalamin production, elevating total serum B12 Laboratory interference : Macro-B12 (immunoglobulin-bound B12) and assay interference can cause spuriously elevated results without true excess In clinical practice, unexplained hypercobalaminaemia should prompt investigation for underlying disease, particularly in patients without obvious supplementation history
See also Iron deficiency Patient Blood Management and surgery Blood product prescription The Australian Red Cross Blood Service anaemia and haemostasis overview Key Points Iron deficiency is the most common cause of anaemia in children Consider admission and discussion with local paediatrician or haematologist for children with red flag features Background Anaemia is defined as haemoglobin (Hb) less than the lower limit of the reference range for age Assessment History Lethargy Poor concentration Weakness Shortness of breath Ethnic background (can be helpful in guiding investigation for haemoglobinopathies and G6PD deficiency) Medication history: past and current, particularly those that may cause haemolysis in children with G6PD deficiency Dietary history: iron intake (with particular attention to iron-rich foods, breast feeding and cow milk intake), vitamin B12 intake, recent fava/broad bean ingestion (may precipitate haemolysis in children with G6PD deficiency) Family history: anaemia, jaundice, gallstones or splenomegaly Examination Poor growth Listlessness or fatigue Pallor Pale conjunctivae Tachycardia Cardiac murmur Signs of cardiac failure Shortness of breath Weakness Signs of haemolysis (jaundice, scleral icterus, splenomegaly and dark urine) Management Investigations FBC and film Reticulocyte count Ferritin Iron studies or serum iron should not be requested to diagnose iron deficiency
Thus, individuals with food-bound vitamin B 12 malabsorption do not have an increased requirement for vitamin B 12
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