Vitamin B12 Deficiency and Folate Deficiency

Vitamin B12 Deficiency Testing and health information

A diagnosis of vitamin B12 or folate deficiency anemia can often be made based on your symptoms and the results of vitamin b12 tests. If you have symptoms of Vitamin B12 and folate deficiency, it's essential to get tested. Learn about the different types of blood tests here.    


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Folate levels have diagnostic significance in nutritional deficiencies, especially in cases of severe alcoholism, function damage to the upper third of small bowel, pregnancy and various forms of megoblastic anemia. Since serum folate levels are subject to rapid changes reflecting diet and absorption, RBC folate may be a better diagnostic tool since the levels remain fairly constant.

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Folic acid deficiency is common in pregnant women, alcoholics, in patients whose diets do not include raw fruits and vegetables, and in people with structural damage to the small intestine. The most reliable and direct method of diagnosing folate deficiency is the determination of folate levels in both erythrocytes and serum. Low folic acid levels, however, can also be the result of a primary vitamin B12 deficiency that decreases the ability of cells to take up folic acid

Vitamin B12 is decreased in pernicious anemia, total or partial gastrectomy, malabsorption and certain congenital and biochemical disorders


Folic acid deficiency is common in pregnant women, alcoholics, patients with diets that do not include raw fruits and vegetables, and people with structural damage to the small intestine. The most reliable and direct method of diagnosing folate deficiency is the determination of folate levels in both erythrocytes and serum. Low folic acid levels, however, can also be the result of a primary Vitamin B12 deficiency that decreases the ability of cells to take up folic acid. Vitamin B12 is decreased in pernicious anemia, total

Vitamin B12 Binding Capacity, Unsaturated (Transcobalamin)

Clinical Significance

Vitamin B12 Binding Capacity, Unsaturated (Transcobalamin), binds and transports vitamin B12 in the circulation. Increased concentrations are associated with patients with myeloproliferative disorders. Decreased concentrations are seen in individuals with megaloblastic anemia or Transcobalamin deficiency.

Alternative Name(s) 

Transcobalamin, B12 Binding Capacity


Before ordering this test consider The Complete Blood Count (CBC) with Differential and Platelets Blood Test (Test # 6399) which is a better value.

In Quest's internal studies of more than two thousand patient samples, no significant abnormalities were detected with manual differentials associated with test code 20253 that were not otherwise identified thru the test code 6399 CBC Reflex cascade.

This test is a CBC reflex test and it will include the components of the CBC (Includes Diff/PLT) with Smear Review based upon the test results of the following analytes if are above or below ranges as outlined in the test.

 
 
  • WBC 
  • Hemoglobin 
  • Hematocrit 
  • Platelet 
  • MCV 
  • MCH 
  • MCHC 
  • RBC 
  • RDW 
  • Relative Neutrophil % 
  • Relative Lymphocyte % 
  • Relative Monocyte % 
  • Eosinophil 
  • Basophil 
  • Platelet 

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

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Elevated levels of homocysteine are observed in patients at risk for coronary heart disease and stroke.

Intrinsic Factor, produced by cells lining the stomach, binds vitamin B12 (cyanocobalamin) to facilitate absorption of the vitamin. Blocking antibody impedes the action of Intrinsic Factor as observed in approximately half of the patients who develop pernicious anemia.

Samples should not be collected from a patient who has received Vitamin B12 injection therapy within the last week.


The methylmalonic acid (MMA) test may be used to help diagnose an early or mild vitamin B12 deficiency. It may be ordered by itself or along with a homocysteine test as a follow-up to a vitamin B12 test result that is in the lower end of the normal range.


Methylmalonic acid is metabolized as methylmalonyl CoA from the catabolism of certain amino acids and fatty acids. Methylmalonyl CoA is then converted to Succinic acid by the following reaction: Methylmalonic Acid Methylmalonyl CoA Mutase + B12 Succinic Acid The enzyme Methylmalonyl CoA mutase requires Vitamin B12 (Cobalamin) as a cofacter. MMA is used to evaluate cobalamin deficiency. Elevated serum MMA reflects decreased tissue cobalamin levels and is an early indicator of vitamin B12 deficiency. Cobalamin dependent neurological disease with normal hematologic parameters and serum B12 levels is frequently associated with significant elevations of serum methylmalonic acid. Methylmalonic Acidemia is an autosomal recessive inborn error of metabolism, in which there is a deficiency of the enzyme methylmalonyl CoA mutase, resulting in a large accumulation of MMA in serum and urine. There is also a combined defect in the cobalamin pathway with elevation of both MMA and homocysteine.


Gastric Parietal Cell Antibodies (GPA) test results are used in the diagnosis of pernicious anemia.

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Use in evaluating erythropoietic activity.

Vitamin C is an antioxidant involved in connective tissue metabolism, drug-metabolizing systems, and mixed-function oxidase systems to list a few. Vitamin C deficiency causes scurvy; manifestations include impaired formation of mature connective tissue, bleeding into the skin, weakness, fatigue, and depression.


9 Blood Tests to Help Identify Vitamin B12 and Folate Deficiency

Are you feeling tired, sluggish, or irritable? Have you noticed changes in your digestion? You could be dealing with a vitamin deficiency. 

The majority of people in the United States consume adequate levels of B12 and folate. However, it's estimated that three percent of men and eight percent of women are deficient. 

A vitamin deficiency can come with a number of consequences. It's important to keep an eye on odd symptoms you're experiencing in case you could be a part of the three or eight percent.

If you're looking for a vitamin B12 deficiency test, you'll benefit from having some background information on the deficiency, its symptoms, treatments, etc. So keep reading to learn more. 

What Are Vitamin B12 and Folate?

Along with folate and vitamin C, vitamin B12, also called cobalamin, helps the body make new proteins. The proteins make red and white blood cells, repair cells, and synthesize DNA.

Vitamin B12 is not naturally produced in the body. Therefore, a person needs to get the right amount from their diet. Red meat, fish, poultry, milk, yogurt, and eggs contain cobalamin.

Folate is also a vitamin the body does not make naturally. It's especially important during pregnancy for cell division. It's commonly found in leafy green vegetables, peas and dry beans, liver, yeast, and citrus fruits. 

So, what causes vitamin B12 deficiency? When someone is dealing with a vitamin B12 deficiency, it's most often because they're not getting enough through their diet or supplements.

When it comes to dietary deficiencies, vegans are the most likely to suffer because of the lack of animal products. However, dietary deficiencies are not the only reason people may develop a B12 deficiency. 

Two other reasons someone may be suffering from vitamin B12 deficiency symptoms are inadequate absorption and increased need. If the vitamin B12 absorption process stops, that can cause the body to absorb less than what it needs. In regard to increased need, some diseases and conditions, like pregnancy or cancer, can boost the need for B12. 

Signs and Symptoms of Vitamin B12 and Folate Deficiency 

In some cases, a mild vitamin B12 and folate deficiency causes no symptoms. Minor changes in diet could fix the issue because a person even realizes something is off. As the deficiency worsens, however, the signs and symptoms become significantly more noticeable. 

Some of the most common signs and symptoms of a vitamin B12 deficiency include the following: 

  • Diarrhea
  • Constipation 
  • Dizziness 
  • Fatigue 
  • Muscle weakness 
  • Loss of appetite 
  • Pale skin 
  • Rapid heart rate
  • Irregular heartbeats 
  • Shortness of breath 
  • Sore or smooth tongue and month 
  • Tingling, numbness, and/or burning in the feet, hands, arms, and legs 
  • Paranoia 
  • Irritability 
  • Vision loss 
  • Weight loss 
  • Unsteady movements 
  • Mental confusion 

If you notice signs of a vitamin B12 deficiency, it's important to learn about the blood tests that can confirm or deny your suspected problem. While you may think you need to head to the doctor to get that done, you have online testing options from Ulta Lab Tests to make the process easier.

Consequences of an Untreated Vitamin B12 Deficiency

If a vitamin B12 deficiency goes untreated, there are several potential consequences. The most common is anemia. When your body doesn't make enough red blood cells, you won't have enough oxygen to your tissues and organs. Untreated anemia can result in heart failure. 

Anemia can also cause nerve problems. This is because B12 helps your body produce myelin. Myelin is essentially a protective layer throughout your nervous system. When those layers break down, nerve fibers can get damaged, which can cause numbness. Left untreated, paralysis is possible. 

A vitamin B12 deficiency can also cause mental health issues like depression, anxiety, insomnia, confusion, and visual or audio hallucinations. In extreme cases, patients can experience extrapyramidal symptoms where the body moves uncontrollably. 

Some doctors and scientists believe there is also a connection between B12 deficiencies and brain issues like dementia and Alzheimer's disease. The brain naturally shrinks with age, but depleted B12 can speed up the process by increasing the level of amino acids in the brain. 

Unfortunately, that's not where the consequences stop. Some rarer conditions related to B12 and folate deficiency include infertility, osteoporosis, COPD, and infertility. 

Blood Tests for Vitamin B12 and Folate Deficiency 

If it's suspected you have a vitamin B12 deficiency, there are a number of blood tests that can confirm or deny the suspicion. Folate is typically tested simultaneously, as the signs and symptoms of both deficiencies are similar. 

Does vitamin B12 deficiency show in blood tests? The short answer is yes. There are, however, a number of tests that can be used. Let's take a look at the nine types of blood tests used to diagnose vitamin B12 and folate deficiencies. 

1) Vitamin B12

vitamin B12 test is used to diagnose conditions like anemia and other autoimmune diseases. In addition, in the elderly, the test can help determine the cause of an altered mental state. If a person suffers from a B12 deficiency, their doctor will likely order the test over time to see if the established treatment is effective. 

2) Folate 

While folate is a separate blood test, it is often used together with B12. In addition to detecting illnesses, testing folate levels can provide a general overview of a person's health and nutritional status. 

3) CBC

A CBC, also known as a complete blood count, is used to screen for many conditions and diseases that affect blood cells. The test evaluates red blood cells, white blood cells, and platelets. 

Red blood cells contain hemoglobin, which is the protein that transports oxygen throughout the body. While most red blood cells last 120 days, medical conditions can change that. When a person has vitamin B12 and folate deficiencies, their red blood cells appear abnormal in size and shape.

White blood cells are a crucial part of the body's immune system. So if the body is fighting an infection or inflammation, the numbers will come back abnormal. 

Platelets are cell fragments that assist with clotting. People who have diseases that cause low platelets are at risk of excessive bleeding and bruising. 

4) B Vitamins 

B vitamins are required for metabolism and energy. They're also needed for cell, skin, bone, muscle, organ, and nervous system health. B vitamins are water-soluble, which means you have to eat foods rich in B vitamins to meet your body's needs. 

When you get tested for B vitamins, your doctor will review your levels for thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxal phosphate (B6), biotin (B7), folate (B9), and cobalamin (B12). 

In regard to test results, low levels could indicate a B vitamin deficiency, and high levels can be associated with vitamin toxicity. 

5) Methylmalonic Acid

Testing methylmalonic acid can detect early or mild vitamin B12 deficiency. The acid is needed for metabolism and energy production. As methylmalonic acid rises in your blood, vitamin B12 levels decrease. 

While the body has measures to level the two out, someone with malabsorption issues could experience numbness, swelling, and jaundice. 

6) Homocysteine

Homocysteine is an amino acid. It is present in all cells of the body and is quickly converted into other products. Vitamin B12 and folate, along with B6, are needed to metabolize homocysteine. 

If a blood test reveals homocysteine levels are elevated, the patient could have a B12 deficiency. Additional testing will be needed to get to the root of the problem. 

Higher levels of homocysteine can also indicate a higher risk for stroke, atherosclerosis, coronary heart disease, or peripheral vascular disease. 

7) Intrinsic Factor Antibody 

Intrinsic factor antibodies are proteins made by the immune system. The protein is produced by specialized cells in the lining of the stomach wall. 

During digestion, stomach accidents release vitamin B12 and bind to intrinsic factor antibodies. With an intrinsic factor, vitamin B 12 goes unabsorbed, and a person can develop anemia. 

8) Parietal Cell Antibody 

Parietal cell antibodies are proteins produced by the immune system. The antibodies mistakenly target cells that line the stomach wall. 

You could have this test completed if you or your doctor believes you have pernicious anemia. Pernicious anemia is an autoimmune disease that flares when the body's immune system targets its own tissues. 

9) Gastrin 

Gastrin, produced by the G-cells, is a hormone that's part of the stomach's antrum. This blood test is usually used to evaluate recurrent peptic ulcers and other types of severe abdominal pain or symptoms. 

While this test isn't directly used to diagnose a vitamin B12 deficiency, its results can help you decide your next step. 

gastrin test is commonly used when a patient suffers from diarrhea, abdominal pain, peptic ulcers, and fatigue. 

While most vitamin B12 and folate deficiencies can be identified with tests at the top of the list, you may need additional testing if your results are unclear. 

With the number of tests Ulta Lab Tests offers, you'll be on track to understanding your body's needs in no time. Test results come as quickly as one to two days, so you won't have to wait weeks to find out if you have a deficiency that needs to be addressed. 

Understanding the Results of a Vitamin B12 Deficiency Test 

If your test results confirm you have a vitamin B12 deficiency, you may need to undergo additional testing to reach a diagnosis. 

It's important to note that dietary deficiency of B12 or folate is uncommon in the United States. This is because many foods are fortified with vitamins. 

In some instances, you could have a deficiency because of certain medications. If your test results indicate that, you can talk with your doctor about finding a new treatment method or adding supplements to your diet. 

Treating a Vitamin B12 Deficiency 

In most instances, treating vitamin deficiencies involves changes in diet and adding supplements. 

For a folate deficiency, folic acid supplements are often suggested. However, once the body's folate level is where it needs to be, which can be confirmed with follow-up blood tests, you'll likely be able to stop taking the supplements. 

With a B-12 deficiency, patients usually start with oral supplements, but that's not always enough. If blood tests do not show any improvements with traditional supplements, B12 injections are an option. 

But how long does it take to recover from B12 deficiency? That answer depends on how well you follow your treatment plan and how your body responds. 

If blood tests confirm you have a vitamin B12 and folate deficiency, you'll want to consider asking your doctor questions about your condition and treatment options. Some of the most common questions, and their answers, patients ask include the following: 

Is vitamin B12 deficiency dangerous?

If left untreated, a B12 deficiency can cause serious complications. 

Does vitamin B12 deficiency cause memory loss?

Yes, vitamin B12 deficiency can cause memory loss. 

Can vitamin B12 deficiency cause muscle pain?

Yes, vitamin B12 deficiency can cause muscle pain. 

Can vitamin B12 deficiency cause lightheadedness?

Yes, vitamin B12 deficiency can cause lightheadedness, particularly when a person stands up too quickly. 

Can vitamin B12 deficiency cause insomnia?

Insomnia and fatigue are the most common and debilitating symptoms related to vitamin B12 deficiency. 

Can vitamin B12 deficiency cause fever?

A severe vitamin B12 deficiency can cause a fever. 

Can vitamin B12 deficiency cause dizziness?

Frequent dizziness and vertigo can indicate a vitamin B12 deficiency. 

Cause vitamin B12 deficiency cause diabetes?

No, but diabetes can increase your risk of having a B12 deficiency. 

Can rheumatoid arthritis cause vitamin B12 deficiency? 

Not necessarily, but a portion of patients with RA do have vitamin B12 deficiency. 

Once you have a handle on your vitamin deficiency, you'll be able to get back to living a high-quality life. 

Order Lab Tests Online

For many patients, driving to a hospital or medical facility for bloodwork can be time-consuming and costly. Fortunately, Ulta Lab Tests offers vitamin B12 deficiency test options. 

When you order lab work from Ulta Lab Tests, your results are kept secure and confidential. And you won't have to worry about getting a referral from your doctor, either. We also offer the lowest prices on lab tests, so health insurance isn't a problem if you're not covered. 

If you're ready to take control of your health, contact us today.