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Homocysteine

Serum Vitamin B12 tests are not the most sensitive means of testing for deficiency.[3] A more sensitive means of testing for vitamin B12 deficiency is testing methylmalonic acid and homocysteine levels. Under current "normal" levels for serum vitamin B12, approximately 50% of patients will have subclinical disease.[1] A homocysteine test alone is not sufficient, it should be paired with methylmalonic acid. If just homocysteine levels are elevated, that may point to a Folate deficiency.[2]

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