cool! hey do you have the units for the b12 result by chance?
i was looking for an older resource but stumbled on this instead and it's much better. excerpt:
http://bestpractice.bmj.com/best-practi ... -step.html
Initial diagnostic testing
Serum vitamin B12 remains a useful initial diagnostic test for vitamin B12 deficiency due to its widespread availability and familiarity with the test. However, caution must to used when interpreting the values, as there are no well-defined cut-offs for deficiency. [25]
Generally, serum vitamin B12 can be broken down into 3 values:
Likely vitamin B12 deficiency: <148 picomols/L (<200 picograms/mL)
Possible vitamin B12 deficiency: 148 to 258 picomols/L (201 to 350 picograms/mL)
Unlikely vitamin B12 deficiency: >258 picomols/L (>350 picograms/mL).
An FBC with peripheral smear is useful to determine whether there is evidence of macrocytosis and frank anaemia, leukopenia, or thrombocytopenia. This suggests a more severe and prolonged vitamin B12 deficiency. However, a normal MCV, haemoglobin, and haematocrit are not useful to rule out tissue vitamin B12 deficiency, as many patients with vitamin B12 deficiency may have normal haematological parameters.
A peripheral smear may show the classic hypersegmented polymorphonucleated cells and megalocytes found in severe vitamin B12 deficiency with associated macrocytic anaemia, but is not sensitive to early vitamin B12 deficiency.
Serum folate level measurements were previously recommended, as low serum folate may falsely lower serum vitamin B12 levels. [26] However, in the era of folic acid fortification, concomitant folate deficiency is rare. In parts of the world where nutritional deficiencies are common, testing for concomitant folic acid deficiency and treatment can help clarify whether true vitamin B12 deficiency co-exists.
Clinical assessment of deficiency severity
The severity of the deficiency can be graded clinically as follows:
Mild to moderate neurological manifestations: dysaethesia/paraesthesias, polyneuropathy and depression
Mild to moderate haematological manifestations: usually asymptomatic with normal haematocrit and high normal to mildly elevated MCV.
Severe neurological manifestations: subacute combined spinal degeneration, dementia, or cognitive impairment. Subacute combined spinal degeneration is progressive neurologic degeneration of the posterior and lateral columns of the spinal cord. Patients present with ataxia, decreased vibration sense, muscle weakness, and hyporeflexia.
Severe haematological manifestations: pancytopenia and marked symptomatic anaemia.