MEDIA RELEASE 18 NOVEMBER 2015
Today, the Royal College of Pathologists of Australasia (RCPA) announces a new position statement clarifying the use and interpretation of Vitamin B12 and Folate testing for diagnosing and monitoring deficiency. The RCPA’s position statement provides guidance to clinicians in the context of the recent changes to the relevant items in the Australian
Medical Benefits Schedule (MBS).
Dr Michael Harrison, Vice President of the RCPA, says that B12 and Folate tests are not conducted as routine screening.
“We recommend that Vitamin B12 and Folate deficiencies should only be suspected in patients with neuropsychiatric symptoms, haematological disorders, malabsorption, Type 1 diabetes, in the malnourished and undernourished, or patients taking proton pump inhibitors long term.
“Testing for Vitamin B12 or Folate deficiencies in patients with non-specific symptoms, such as weakness and tiredness is not recommended. As risk factors for Vitamin B12 and Folate deficiency do not generally overlap, levels should not be routinely requested together – except in suspected malabsorption,” says Dr Harrison.
However, Dr Harrison also highlights uncommon cases of deficiency.
“Although rare, severe untreated Vitamin B12 deficiency can lead to permanent neurological damage and maternal folate deficiency is linked to fetal neural tube defects.
Many Vitamin B12 or Folate deficient patients have no clinical signs and the Full Blood
Count (FBC) is often normal, including normal Haemoglobin levels and a normal Mean
Corpuscular Volume,” said Dr Harrison.
Follow up testing should only occur in the presence of haematological abnormalities, via a
Full Blood Count (FBC)/reticulocyte count at one week and one month to confirm normalisation of counts.
Recommendations on how to test:
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.
For more information, visit our website www.rcpa.edu.au
or see our updates on Twitter -
@PathologyRCPA - and Facebook . #PathologyStory #IPD2015 #MedicineIsPathology #RCPA
ENDS
About the Royal College of Pathologists of Australasia:
The RCPA is the leading organisation representing pathologists in Australasia. Its mission is to train and support pathologists and to improve the use of pathology testing to achieve better healthcare.
Media enquiries:
Dr Debra Graves
Chief Executive Officer
The Royal College of Pathologists of Australasia
+61 2 8356 5858
Debrag@rcpa.edu.au
Marco Navarria
Senior Account Manager
S2i Communications
+61 2 9262 4766
Marco@s2i.com.au