Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation

Matchar, D B; Feussner, J R; Millington, D S; Wilkinson, Jr, R H; Watson, D J; Gale, D

doi:10.7326/0003-4819-106-5-707

Title: Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation

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Abstract

Vitamin B12 deficiency is a frequently considered diagnosis for which there is no single, commonly available and accurate test. A urinary methylmalonic acid assay using gas chromatography-mass spectrometry has been proposed as the preferred test. We reviewed vitamin B12 assays on 1599 consecutive patients and prospectively studied all patients with low serum B12 levels (n = 75) and a random sample of patients with normal levels (n = 68). Of 96 evaluable patients, 7 had clinical deficiency. All 7 deficient patients had urinary methylmalonic acid levels greater than 5 micrograms/mg creatine (sensitivity, 100%; confidence interval, 65% to 100%). Of the 89 patients who were not clinically deficient, 88 had urinary methylmalonic acid levels less than or equal to 5 micrograms/mg creatinine (specificity, 99%). The overall test accuracy in this population was 99%. If the high sensitivity and specificity of the gas chromatography-mass spectrometry assay for urinary methylmalonic acid is supported by other clinical studies, the methylmalonic acid assay may become the reference standard for the diagnosis of vitamin B12 deficiency.

Authors:: Matchar, D B; Feussner, J R; Millington, D S; Wilkinson, Jr, R H; Watson, D J; Gale, D

Publication Date:: Fri May 01 00:00:00 EDT 1987

Research Org.:: Durham VA Medical Center, NC

OSTI Identifier:: 6520874

Resource Type:: Journal Article

Journal Name:: Ann. Intern. Med.; (United States)

Additional Journal Information:: Journal Volume: 5

Country of Publication:: United States

Language:: English

Subject:: 59 BASIC BIOLOGICAL SCIENCES; MALONIC ACID; BIOASSAY; VITAMIN B-12; NUTRITIONAL DEFICIENCY; DIAGNOSIS; GAS CHROMATOGRAPHY; ISOTOPE DILUTION; MASS SPECTROSCOPY; PATIENTS; URINE; BIOLOGICAL MATERIALS; BIOLOGICAL WASTES; BODY FLUIDS; CARBOXYLIC ACIDS; CHROMATOGRAPHY; DICARBOXYLIC ACIDS; DRUGS; HEMATINICS; HEMATOLOGIC AGENTS; ISOTOPE APPLICATIONS; MATERIALS; ORGANIC ACIDS; ORGANIC COMPOUNDS; SEPARATION PROCESSES; SPECTROSCOPY; TRACER TECHNIQUES; VITAMIN B GROUP; VITAMINS; WASTES; 550901* - Pathology- Tracer Techniques

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                    Matchar, D B, Feussner, J R, Millington, D S, Wilkinson, Jr, R H, Watson, D J, and Gale, D. Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation.  United States: N. p., 1987. 
        Web.  doi:10.7326/0003-4819-106-5-707.

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                    Matchar, D B, Feussner, J R, Millington, D S, Wilkinson, Jr, R H, Watson, D J, & Gale, D. Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation.  United States.  https://doi.org/10.7326/0003-4819-106-5-707

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                    Matchar, D B, Feussner, J R, Millington, D S, Wilkinson, Jr, R H, Watson, D J, and Gale, D. 1987.  
        "Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation".  United States.  https://doi.org/10.7326/0003-4819-106-5-707.

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@article{osti_6520874,

  title        = {Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation},

  author       = {Matchar, D B and Feussner, J R and Millington, D S and Wilkinson, Jr, R H and Watson, D J and Gale, D},

  abstractNote = {Vitamin B12 deficiency is a frequently considered diagnosis for which there is no single, commonly available and accurate test. A urinary methylmalonic acid assay using gas chromatography-mass spectrometry has been proposed as the preferred test. We reviewed vitamin B12 assays on 1599 consecutive patients and prospectively studied all patients with low serum B12 levels (n = 75) and a random sample of patients with normal levels (n = 68). Of 96 evaluable patients, 7 had clinical deficiency. All 7 deficient patients had urinary methylmalonic acid levels greater than 5 micrograms/mg creatine (sensitivity, 100%; confidence interval, 65% to 100%). Of the 89 patients who were not clinically deficient, 88 had urinary methylmalonic acid levels less than or equal to 5 micrograms/mg creatinine (specificity, 99%). The overall test accuracy in this population was 99%. If the high sensitivity and specificity of the gas chromatography-mass spectrometry assay for urinary methylmalonic acid is supported by other clinical studies, the methylmalonic acid assay may become the reference standard for the diagnosis of vitamin B12 deficiency.},

  doi          = {10.7326/0003-4819-106-5-707},

  url          = {https://www.osti.gov/biblio/6520874},
  journal      = {Ann. Intern. Med.; (United States)},
number       = ,

  volume       = 5,

  place        = {United States},

  year         = {Fri May 01 00:00:00 EDT 1987},

  month        = {Fri May 01 00:00:00 EDT 1987}

}

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