Vitamin-related laboratory tests in patients with definite responses to Cbl therapy
. | . | sFol, ng/mL/rFol, g/mL . | MMA, nmol/L . | . | HCys, μmol/L . | . | BUN, g/dL/Cr, mg/dL . | . | . | ||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Case . | Cbl, pg/mL . | . | Before Rx . | After Rx . | Before Rx . | After Rx . | . | TSH, mIU/L . | EtOH . | ||
| 1 | 137; 235 | 18.8/611 | ”< 400” | ND | ND | ND | ND | 1.6 | No | ||
| 2 | 163; 156 | 17.9/ND | 1829 | 180 | 40.4 | 13.9 | 27/1.0 | 1.5 | Yes | ||
| 3* | 281; 343 | 6.6/229 | 419; 363 | 183 | 40.4; 60.7 | 75.8† | 11/1.2 | 2.75 | Yes | ||
| 4 | 159 | ND/288 | ”< 400” | ND | 4.5 | ND | 5/0.4 | 1.7 | No | ||
| 5 | 201; 201 | ND/ND | ND | 172 | ND | ND | 19/0.6 | 0.7 | No | ||
| 6‡ | 216; 275 | 5.6/ND | 600 | ND‡ | 39.9 | ND‡ | 42/2.1 | 1.2 | No | ||
| 7 | 356; 234 | > 20/280 | 444; 389 | 138 | 5.9 | ND | 12/0.7 | 1.3 | No | ||
| 8 | 225; 218 | ND/ND | 549; 497 | 237 | 3.0 | ND | 14/0.7 | ND | No | ||
| 9 | 281; 343 | > 20/ND | 546; 426 | 209 | 18.5; 15.5 | 11.4 | 25/1.3 | 2.8 | No | ||
| 10 | 416; 806 | 13.4/ND | 321; 274 | 199 | 9.8; 11.0 | 7.9 | 32/1.1 | 1.55 | No | ||
| 11 | 942 | 16.3/ND | 314 | 385 | 16.8 | 17.8§ | 26/2.3 | ND | No | ||
| 12 | 364; 545 | > 20/ND | 202; 244 | 113 | 16.1; 11.8 | 9.0 | 11/1.1 | 0.38 | No | ||
| 13 | 409 | ND/ND | 145 | ND | 8.9 | ND | 19/1.0 | ND | No | ||
| 14 | 916 | > 20/ND | 326; 286 | 223 | 16.7; 17.5 | 14.8 | 20/1.3 | ND | No | ||
| 15 | 567; 706 | 17.1/ND | 323; 313 | 199 | 12.2; 13.7 | 11.5 | 18/1.2 | 1.16 | No | ||
| 16 | 279; 263 | > 20/ND | 257 | 137 | 13.2 | 10.4 | 16/1.0 | 5.38 | No | ||
| 17 | 287; 329 | 12.7/ND | 362; 288 | 256 | 17.7; 14.4 | 8.9 | 26/0.9 | 4.6 | No | ||
| 18 | 423; 420 | 12.3/ND | 397; 328 | 253 | 10.7; 8.0 | 8.8 | 22/1.4 | 1.85 | No | ||
| 19 | 297; 298 | 14.2/ND | 478; 377 | 255 | 11.9; 11.4 | 10.7 | 17/0.8 | 4.1 | No | ||
| 20 | 762 | ND/ND | 140 | ND | 9.4 | ND | 13/1.0 | 4.08 | No | ||
| 21 | 517; 565 | 13.7/ND | 164; 157 | ND | 12.0; 11.4 | ND | 12/1.2 | 2.45 | No | ||
| 22 | 344; 337 | 12.2/ND | 309; 261 | 171 | 17.9; 17.2 | 17.1 | 17/1.1 | 2.64 | Yes | ||
| 23 | 478; 458 | > 20/ND | 258; 305 | 166 | 9.4 | ND | 16/1.1 | 1.44 | No | ||
| 24 | 522 | ND/ND | 137 | ND | 8.7 | ND | 10/0.9 | 1.31 | No | ||
| 25 | 174; 253 | ND/ND | ND | ND | ND | ND | 7/0.5 | 0.80 | No | ||
| 26 | 344 | 14.7/203 | 375 | 121 | 10.4 | ND | 18/0.7 | 0.92 | No | ||
| 27 | 155 | ND/346 | 1928 | 189 | 29.3 | 7.2 | 11/0.8 | ND | No | ||
| 28 | 587 | 7.9/ND | 255; 298 | 179 | 18.1; 18.4 | 13.8 | 23/1.4 | ND | No | ||
| 29 | 469 | > 20/ND | 270; 329 | 202 | 8.9 | 7.0 | 17/0.9 | 0.72 | No | ||
| 30 | 724; 537 | > 20/ND | 265; 288 | 222 | 14.6; 11.1 | 6.2 | 15/0.8 | 3.36 | No | ||
| 31 | 540; 605 | ND/ND | 312; 349 | 165 | 4.8; 7.2 | ND | 10/0.8 | 2.28 | No | ||
| 32 | 286; 357 | 18.2/ND | 590; 487 | 119 | 13.6; 18.9 | 14.0§ | 58/2.4 | 1.87 | No | ||
| 33 | 161 | 14.3/ND | 1006 | 133 | 9.8 | 5.5 | 9/0.9 | 1.29 | No | ||
| 34 | 270; 279 | ND/ND | 425; 639 | 132 | 11.3; 13.1 | 7.8 | 10/1.0 | 2.2 | No | ||
| 35 | 370 | > 20/ND | 296 | 143 | 9.4 | 6.5 | 21/1.1 | 0.60 | No | ||
| 36 | 356 | 11.0/ND | 222 | ND | 10.5 | ND | 16/1.3 | 1.06 | No | ||
| 37 | 1623; 675 | > 20/935 | 341; 520 | 300 | 11.4; 17.2 | 9.3 | 23/1.4 | 2.08 | No | ||
. | . | sFol, ng/mL/rFol, g/mL . | MMA, nmol/L . | . | HCys, μmol/L . | . | BUN, g/dL/Cr, mg/dL . | . | . | ||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Case . | Cbl, pg/mL . | . | Before Rx . | After Rx . | Before Rx . | After Rx . | . | TSH, mIU/L . | EtOH . | ||
| 1 | 137; 235 | 18.8/611 | ”< 400” | ND | ND | ND | ND | 1.6 | No | ||
| 2 | 163; 156 | 17.9/ND | 1829 | 180 | 40.4 | 13.9 | 27/1.0 | 1.5 | Yes | ||
| 3* | 281; 343 | 6.6/229 | 419; 363 | 183 | 40.4; 60.7 | 75.8† | 11/1.2 | 2.75 | Yes | ||
| 4 | 159 | ND/288 | ”< 400” | ND | 4.5 | ND | 5/0.4 | 1.7 | No | ||
| 5 | 201; 201 | ND/ND | ND | 172 | ND | ND | 19/0.6 | 0.7 | No | ||
| 6‡ | 216; 275 | 5.6/ND | 600 | ND‡ | 39.9 | ND‡ | 42/2.1 | 1.2 | No | ||
| 7 | 356; 234 | > 20/280 | 444; 389 | 138 | 5.9 | ND | 12/0.7 | 1.3 | No | ||
| 8 | 225; 218 | ND/ND | 549; 497 | 237 | 3.0 | ND | 14/0.7 | ND | No | ||
| 9 | 281; 343 | > 20/ND | 546; 426 | 209 | 18.5; 15.5 | 11.4 | 25/1.3 | 2.8 | No | ||
| 10 | 416; 806 | 13.4/ND | 321; 274 | 199 | 9.8; 11.0 | 7.9 | 32/1.1 | 1.55 | No | ||
| 11 | 942 | 16.3/ND | 314 | 385 | 16.8 | 17.8§ | 26/2.3 | ND | No | ||
| 12 | 364; 545 | > 20/ND | 202; 244 | 113 | 16.1; 11.8 | 9.0 | 11/1.1 | 0.38 | No | ||
| 13 | 409 | ND/ND | 145 | ND | 8.9 | ND | 19/1.0 | ND | No | ||
| 14 | 916 | > 20/ND | 326; 286 | 223 | 16.7; 17.5 | 14.8 | 20/1.3 | ND | No | ||
| 15 | 567; 706 | 17.1/ND | 323; 313 | 199 | 12.2; 13.7 | 11.5 | 18/1.2 | 1.16 | No | ||
| 16 | 279; 263 | > 20/ND | 257 | 137 | 13.2 | 10.4 | 16/1.0 | 5.38 | No | ||
| 17 | 287; 329 | 12.7/ND | 362; 288 | 256 | 17.7; 14.4 | 8.9 | 26/0.9 | 4.6 | No | ||
| 18 | 423; 420 | 12.3/ND | 397; 328 | 253 | 10.7; 8.0 | 8.8 | 22/1.4 | 1.85 | No | ||
| 19 | 297; 298 | 14.2/ND | 478; 377 | 255 | 11.9; 11.4 | 10.7 | 17/0.8 | 4.1 | No | ||
| 20 | 762 | ND/ND | 140 | ND | 9.4 | ND | 13/1.0 | 4.08 | No | ||
| 21 | 517; 565 | 13.7/ND | 164; 157 | ND | 12.0; 11.4 | ND | 12/1.2 | 2.45 | No | ||
| 22 | 344; 337 | 12.2/ND | 309; 261 | 171 | 17.9; 17.2 | 17.1 | 17/1.1 | 2.64 | Yes | ||
| 23 | 478; 458 | > 20/ND | 258; 305 | 166 | 9.4 | ND | 16/1.1 | 1.44 | No | ||
| 24 | 522 | ND/ND | 137 | ND | 8.7 | ND | 10/0.9 | 1.31 | No | ||
| 25 | 174; 253 | ND/ND | ND | ND | ND | ND | 7/0.5 | 0.80 | No | ||
| 26 | 344 | 14.7/203 | 375 | 121 | 10.4 | ND | 18/0.7 | 0.92 | No | ||
| 27 | 155 | ND/346 | 1928 | 189 | 29.3 | 7.2 | 11/0.8 | ND | No | ||
| 28 | 587 | 7.9/ND | 255; 298 | 179 | 18.1; 18.4 | 13.8 | 23/1.4 | ND | No | ||
| 29 | 469 | > 20/ND | 270; 329 | 202 | 8.9 | 7.0 | 17/0.9 | 0.72 | No | ||
| 30 | 724; 537 | > 20/ND | 265; 288 | 222 | 14.6; 11.1 | 6.2 | 15/0.8 | 3.36 | No | ||
| 31 | 540; 605 | ND/ND | 312; 349 | 165 | 4.8; 7.2 | ND | 10/0.8 | 2.28 | No | ||
| 32 | 286; 357 | 18.2/ND | 590; 487 | 119 | 13.6; 18.9 | 14.0§ | 58/2.4 | 1.87 | No | ||
| 33 | 161 | 14.3/ND | 1006 | 133 | 9.8 | 5.5 | 9/0.9 | 1.29 | No | ||
| 34 | 270; 279 | ND/ND | 425; 639 | 132 | 11.3; 13.1 | 7.8 | 10/1.0 | 2.2 | No | ||
| 35 | 370 | > 20/ND | 296 | 143 | 9.4 | 6.5 | 21/1.1 | 0.60 | No | ||
| 36 | 356 | 11.0/ND | 222 | ND | 10.5 | ND | 16/1.3 | 1.06 | No | ||
| 37 | 1623; 675 | > 20/935 | 341; 520 | 300 | 11.4; 17.2 | 9.3 | 23/1.4 | 2.08 | No | ||
Normal values not given in the body of text were as follows: sFol, more than 5.4 ng/mL; rFol, 145 ng/mL or more; BUN, 7 to 30 mg/dL; Cr, 0.5 to 1.3 mg/dL; TSH, 0.35 to 5.50 mIU/L.
Cbl indicates cobalamin; sFol, serum folate; rFol; red cell folate; MMA, methylmalonic acid; HCys, homocysteine; BUN, blood urea nitrogen; Cr, serum creatinine; TSH, thyroid stimulating hormone; EtOH; ethanol abuse; before Rx, prior to cobalamin therapy; after Rx, after cobalamin therapy; ND, not done.
Patient 3 had both hematologic and neurologic responses to Cbl therapy
HCys level returned to normal when patient 3 abstained from EtOH.
Patient 6 later relapsed off Cbl therapy with an MMA value of 1110 nmol/L and an HCys value of 32.2 μmol/L. Reinstitution of Cbl therapy led to a fall of MMA to 332 nmol/L and HCys to 18.7 μmol/L despite a persistent serum creatinine level of 2.2 mg/dL.
Persistent high HCys level in these patients (patients 11 and 32) may relate to chronic renal failure (creatinine, 2.3 and 2.4, respectively).