Changes to requesting of vitamin B12 and folate

You will recall in February we made changes to the requesting of vitamin B12 and folate. See article in The Scope for information.

In Summary:

  • B12 testing frequency is very high and increasing well beyond population growth rate.
  • There is a high frequency of repeat testing (<12 months) with little evidence of clinical benefit.
  • More focused testing is recommended (some at risk groups are likely to be undertested).
  • There is no justification for routinely requesting B12 and folate together and this will be modified.
  • Indications for folate testing are very limited.

We initiated the following changes:

  • We separated vitamin B12 and folate requests on the electronic ordering form and they now appear on a second-tier page.
  • An appropriate indication to request B12 is now required using a dropdown-box.
  • Electronic order forms will show if a previous B12 result has been requested within 12 months (grey font).

We are now implementing phase two of the strategy. We know that some Patient Management Systems (PMS) are still set up to order the combined B12/folate together, and there are also still some pre-printed laboratory forms that have the combined B12/folate as one order.

From July 15, 2024, all B12/folate combinations will only be tested for a B12.  If serum folate is still required, please email us to add the test (within 2 days of submission) –

Awanui Labs Auckland will add the following comment to these combined B12/folate results:

Folate testing is no longer being routinely performed in conjunction with B12 testing. In future, please order tests independently. B12 testing is currently being performed on the sample. Folate deficiency is rare and should only be ordered in very specific clinical situations (see previous article in The Scope) . If serum folate is still required, please email to add the test. The sample remains suitable for only 2 days.