Changes to vitamin B12 and folate

Rates of B12 testing are very high, often for no clear reason, and growth is unsustainable. There is a high frequency of repeat testing within 12 months, with little evidence of clinical benefit.

Over testing of B12 is a local and worldwide phenomenon and is increasing far beyond demographic factors (e.g. population growth, migration, age) as possible explanations. The Canterbury region is no exception. There is no justification for routinely requesting B12 and folate together and indications for folate testing are very limited.

From Tuesday 4 June 2024 the following changes will be initiated:

  • Vitamin B12 and folate will be separated and will appear on the second-tier page of electronic order forms.
  • An appropriate indication to request B12 will be required using a dropdown-box with options provided. However, a patient charge option will be available.
  • Electronic order forms will show if a previous B12 result has been requested within 12 months (grey font, hover).
  • Any eOrder My Tab groups with B12 and folate together will be amended to leave B12 only. Requestors will need to go in to their My Tab and amend it if they still require folate.
  • We ask that any forms produced outside of our electronic eOrders be amended to have B12 and Folate shown separately, and a clinical indication stated.

Testing is recommended in the following settings:

  • Haematologic: unexplained anaemia, macrocytosis
  • Unexplained neurological or neuropsychiatric symptoms, e.g. subacute combined degeneration of the cord, peripheral neuropathy, dementia, unexplained neurology
  • GI disorders, e.g. Crohn’s diseases, coeliac disease, glossitis or other stomach or small intestinal disorders, previous gastric resection etc.
  • Medication related: metformin, prolonged use of proton pump inhibitors or H2 receptor antagonists
  • Pregnancy and lactation where deficiency is suspected
  • Infants and children with risk factors for deficiency or unexplained developmental delay
  • Long term vegan and vegetarian diets
  • Elderly patients >75 years
  • Patient to pay and discussed with patient $ charge

Please find further information on this decision here.

We thank you for your understanding and support with this change.