Efficacy of Vitamin B12 and Folate Testing in an Urban Teaching Hospital Katrina Bellan, Dietetic Intern, Virginia Tech, Northern Virginia; Gary Ecelbarger MS, RD, LD, CNSC, Medstar Washington Hospital Center, Washington DC Background References Methods Results Conclusion  Vitamin B12 and folate is frequently tested in the presence of elevated mean corpuscular volume (MCV)  Observations made by RDs question the efficacy of this practice  Folate is tested in patients with a history of alcoholism and drug abuse due to altered metabolism of the nutrient  Vitamin B12 is frequently tested in patients with advanced age.  It is believed that about 15% of people over the age of 60 are deficient in vitamin B12 due to decreased intrinsic factor (1).  Triggers for screening vitamin B12 deficiency include gastritis, gastrointestinal resectioning, conditions impacting the small intestine, pancreatic insufficiency, alcohol and drug abuse, and altered cognitive function (1,2,3). Discussion and Limitations Folate and vitamin B12 deficiencies in the hospitalized population are rarer than previously suggested by the literature. Folate deficiency is so rare that testing is unnecessary and not cost effective. Previously accepted diagnostic tools to assess risk for B12 deficiency need to be reevaluated. Data was collected from electronic medical records using Azyxxi medical software. A filter was applied to the program to collect retrospective data on patients whose vitamin B12 and folate levels were tested in the past 6 months. Low levels were individually extracted along with potentially relative criteria including age, gender, MCV, RDW, and relative medical history. The population reviewed in this study was patients admitted to Washington Hospital Center from June 1, 2011 to November 30, 2011 with clinically defined low vitamin B12 and folate levels of less than 254 mg/dL and less than 2.8 mg/dL respectively. Due to inconsistencies in medical charts, data was retrieved from current diagnosis as well as past medical history depending on availability. Some patients fell under multiple categories if they had multiple comorbidities related to low serum B12.  Folate levels appear to be the chief reason for unnecessary lab draws. Reducing testing for this micronutrient would reduce laboratory time and cost.  The most significant marker for potentially low serum B12 levels was found in patients over the age of 60, however with a much lower incidence than suggested by the literature.  No connection was recognized between elevated MCV and low B12 levels.  Duplicate lab draws as well as lab errors were included in the total lab draws.  Since such a small number of patients had low folate levels, no further analysis of deficiency comorbidities was conducted.  The possibly of folate supplementation administration prior to laboratory testing may have influenced results. 1.Gropper, S., Smith, J., & Groff, J. (2009). Advanced nutrition and human metabolism. (Fifth ed.). Belmont, CA: Wadsworth. 2.Andres, E., Loukili, N., Noel, E., Kaltenbach, G., Abdelgheni, M., Perrin, A., Noblet-Dick, M., & Maloisel, F. (2004). Vitamin b12 (cobalamin) deficiency in elderly patients. Canadian Medical Association, Retrieved from on Oct Clark, R., Evans, J., Schneede, J., Nexo, E., Bates, C., Fletcher, A., Prentice, A., & Johnston, C. (2004). Vitamin b12 and folate deficiency in later life. Age and Ageing, Retrieved from on Oct 2011 Comorbidities associated with vitamin B12 deficiency Number of laboratory tests associated with deficiency ≥ 60 years of age32 < 60 years of age9 Elevated MCV 3 GI related diagnosis or history5 Altered mental status or psychotic disorders6 Long term medication use, alcohol abuse, tobacco use 6 Purpose  To determine the frequency with which vitamin B12 and folate testing is conducted at Washington Hospital Center  Assess the efficacy of vitamin B12 testing within an anecdotally suggested at risk group Table 1: Distribution of Vitamin B12 and Folate Laboratory Draws and Deficiencies over 6 Months Laboratory test Number of laboratory tests conducted Total Folate and B12 lab draws for 6 months3693 Patients with Folate levels below normal (<2.6 mcg)7 Patients with B12 levels below normal (<254 mcg) 41 (21 female, 20 male) Table 2: Distribution of Comorbidities Associated with Vitamin B12 Deficiency over 6 Months  Supplementation is effective in improving serum folate levels and should be used in patients with suspected deficiency, in place of lab draws. Elevated MCV should not be considered indicative of low B12 levels. B12 testing is difficult to restrict since the rate of deficiency is equal to three patients every two weeks, making it difficult to restrict lab draws.  In future studies, a prospective design should be used to focus on specific populations at risk for micronutrient deficiency. Recommendations Micronutrient deficiency Rate of nutrient deficiency among laboratory tests Folate ≤ 0.2% Vitamin B12 in population ≥ 60 years of age< 2% Table 3: Prevalence of Folate Deficiency in WHC Population and B12 Deficiency in Subgroup ≥ 60 Years of Age I would like to thank Gary Ecelbarger for his support and guidance in conducting this study. Folate Vitamin B12