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Holotranscobalamin as an Indicator of Vitamin B₁₂ Deficiency in Gastrectomized Patients

Address correspondence to Young Kyung Lee, M.D., Ph.D., Department of Laboratory Medicine, Hallym University College of Medicine, 896 Pyungchondong, Dongangu, Anyang, Gyunggido, 431-070 Korea; tel 82 31 380 3930; fax 82 31 380 3934; e-mail lyoungk{at}hallym.or.kr.

Transcobalamin-bound vitamin B₁₂, or holotranscobalamin (HoloTC), a biologically active form, is believed to be a sensitive marker of vitamin B₁₂ deficiency. We investigated the prevalence of vitamin B₁₂ deficiency in gastrectomized patients using HoloTC and total vitamin B₁₂ to determine the diagnostic utility of HoloTC. We enrolled 128 gastrectomized patients and measured serum HoloTC, total vitamin B₁₂, homocysteine (Hcy), and complete blood count (CBC). HoloTC values were also obtained from 100 healthy controls. The precision of HoloTC measurement was good and the normal range of HoloTC was set at 42.48 pmol/L. Among the 128 gastrectomized subjects, HoloTC was low (<42.48 pmol/L) in 32 patients (25.0%) and total vitamin B₁₂ was low (<189 pg/ml) in 10 patients (7.8%). Among the patients who had total vitamin B₁₂ concentrations in the borderline range (189~400 pg/ml), 44% had low HoloTC concentrations. Clinical findings as well as Hcy concentrations suggested vitamin B₁₂ deficiency in this subset of patients. The patients with both low total vitamin B₁₂ and low HoloTC had significantly higher Hcy concentrations than those with either normal total vitamin B₁₂ or normal HoloTC. Although a quarter of gastrectomized patients had low HoloTC, some of these had normal total vitamin B₁₂ concentrations. Our study suggests that serum HoloTC is a more sensitive marker than total vitamin B₁₂ in diagnosing vitamin B₁₂ deficiency.

Keywords: holotranscobalamin, vitamin B₁₂ deficiency, gastrectomy, homocysteine