Health Encyclopedia

Vitamin B12 level

Definition

The vitamin B12 level is a test to tell how much vitamin B12 is in your blood.

How the test is performed

Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.

A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. The band is removed to let the blood flow again. Once the blood has been collected, the needle is removed. The puncture site is covered to stop any bleeding.

In infants or young children, the area is cleansed with antiseptic and punctured with a sharp needle or a small blade (lancet). The blood may be collected in a small glass tube (pipette), on a slide, onto a test strip, or into a small container. A bandage may be placed on the puncture site if there is any bleeding.

How to prepare for the test

You should not eat or drink for about 6 - 8 hours before the test. Tell your health care provider if you are taking any medicines that may affect test results, including colchicine, neomycin (Neosporin), para-aminosalicylic acid, and phenytoin (Dilantin).

How the test will feel

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

This test is most often done when other tests (which may include CBC, RBC indices, reticulocyte count, blood smear, or others) suggest a blood disorder called megaloblastic anemia.

Pernicious anemia is the megaloblastic anemia caused by poor vitamin B12 absorption. This can occur when the stomach makes less intrinsic factor, a substance needed for vitamin B12 absorption. This test may also be done to find the cause of nervous system problems.

Normal Values

Normal values are 200 - 900 pg/mL (picograms per milliliter).

What abnormal results mean

Values of less than 200 pg/mL show a lack (deficiency) of vitamin B12. People with this deficiency are likely to have or develop symptoms. Older adults with vitamin B12 levels between 200 and 500 pg/mL may also have symptoms.

Causes of vitamin B12 deficiency include:

Not enough vitamin B12 in diet (rare except with a strict vegetarian diet)
Poor absorption (malabsorption) diseases (for example, celiac disease and sprue)
Lack of intrinsic factor
Above normal heat production (hypermetabolic state - for example, with hyperthyroidism)
Pregnancy

Increased vitamin B12 levels are uncommon. Usually excess vitamin B12 is removed in the urine. But disorders that affect the levels of vitamin B12 in the blood can lead to too much vitamin B12. These disorders include:

Liver disease (such as cirrhosis or hepatitis)
Myeloproliferative disorders (for example, myelocytic leukemia)

Other conditions under which the test may be done:

What the risks are

Risks from having blood drawn are slight:

Excess bleeding
Fainting or feeling light-headed
Blood under the skin (hematoma)
Infection
Many needle sticks to find veins

Special considerations

The health care provider will usually take blood or red blood-cell folate levels when testing for megaloblastic anemias of any kind.

The blood test for levels of vitamin B12 has become much more accurate within the past few years. Now, there are fewer false-normal results, because the test only measures biologically active B12.

A Schilling test can find the cause of a vitamin B12 deficiency.

Rupture of some of the red blood cells (hemolysis) in the blood sample may affect test results.

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Getting a blood sample from some people may be harder than from others.

References

Antony AC. Megaloblastic anemias. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23nd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 170.

Reynolds E. Vitamin B12, folic acid, and the nervous system. The Lancet Neurology. Nov 2006;5(11):949-60.

Review Date:10/10/2008
Reviewed By:A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Mark Levin, MD, Hematologist and Oncologist, Newark, NJ. Review provided by VeriMed Healthcare Network (3/13/2007).

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