martes, 23 de septiembre de 2014

National Guideline Clearinghouse | Guidelines for the diagnosis and treatment of cobalamin and folate disorders.

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National Guideline Clearinghouse | Guidelines for the diagnosis and treatment of cobalamin and folate disorders.



British Committee for Standards in Haematology

National Guideline Clearinghouse (NGC)

Guideline Title
Guidelines for the diagnosis and treatment of cobalamin and folate disorders.
Bibliographic Source(s)
Devalia V, Hamilton MS, Molloy AM, the British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014 Aug;166(4):496-513. [147 references] PubMed External Web Site Policy
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Guidelines on the investigation and diagnosis of cobalamin and folate deficiencies. A publication of the British Committee for Standards in Haematology. BCSH General Haematology Test Force. Clin Lab Haematol. 1994 Jun;16(2):101-15.
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Guidelines for the diagnosis and treatment of ... [Br J Haematol. 2014] - PubMed - NCBI

 2014 Aug;166(4):496-513. doi: 10.1111/bjh.12959. Epub 2014 Jun 18.

Guidelines for the diagnosis and treatment of cobalamin and folate disorders.

Abstract

The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status because there is no 'gold standard' test to define deficiency. Serum cobalamin currently remains the first-line test, with additional second-line plasma methylmalonic acid to help clarify uncertainties of underlying biochemical/functional deficiencies. Serum holotranscobalamin has the potential as a first-line test, but an indeterminate 'grey area' may still exist. Plasma homocysteine may be helpful as a second-line test, but is less specific than methylmalonic acid. The availability of these second-line tests is currently limited. Definitive cut-off points to define clinical and subclinical deficiency states are not possible, given the variety of methodologies used and technical issues, and local reference ranges should be established. In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment. Treatment of cobalamin deficiency is recommended in line with the British National Formulary. Oral therapy may be suitable and acceptable provided appropriate doses are taken and compliance is not an issue. Serum folate offers equivalent diagnostic capability to red cell folate and is the first-line test of choice to assess folate status.
© 2014 John Wiley & Sons Ltd.

KEYWORDS:

cobalamin; folate; holotranscobalamin; intrinsic factor antibody; methylmalonic acid

PMID:
 
24942828
 
[PubMed - indexed for MEDLINE]

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