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Using this serum vitamin B 12 cut-off alone, the prevalence of vitamin B 12 deficiency is estimated to be in the range of 5% to 15%.3 4 5 6 However, when higher serum vitamin B 12 cut-off at 258 pmol/L (350 pg/mL) or using elevated serum homocysteine or MMA level in addition to a low or low-to-normal serum vitamin B 12 level to diagnose vitamin B 12 deficiency, the prevalence of deficiency increases to 40.5%.1 3 Also, the prevalence of vitamin B 12 deficiency appears to increase with age among the elderly population.4 5 Furthermore, reports have indicated that institutionalised elderly with multiple co-morbidities and with increasing dependency are more prone to vitamin B 12 deficiency than non-institutionalised (free-living) elderly

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Inflammation haptocorrin levels can increase due to granulocyte activation or as an acute phase response Decreased clearance: Renal failure decreased clearance of transcobalaminB12 complexes Mechanism: Most elevated B12 is not free or biologically active , but rather bound to haptocorrin , which has a long half-life and is increased in certain diseases