Dr. Goswami Parth Rajendragiri
Pathology
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Patient's Query
Hello doctor,
I recently had my annual exam done and have had some odd results. Vitamin B12 was over 2000 ng/ml ref range was 200 to 1100. I do not take any b12 or multivitamins. Globulin was 1.8 g/dl ref range 1.9 to 3.7. The albumin/globulin ratio 2.7 range was 1.0 to 2.5. AST 41 u/l ref range was 10 to 40. ALT 83 u/l ref range 9 to 46. Hemoglobin 17.4 g/dl ref range from 13.2 to 17.1. Is this a serious sign of something wrong? I have noticed. I do not feel that great these days. My doctor has put me into getting an ultrasound on my abdomen.
Hello,
Welcome to icliniq.com.
Your B12 level is very high. Liver disease, kidney disease, myeloproliferative blood neoplasm, etc., are some of the causes for elevated B12. Your ALT (alanine transaminase) is high, so for liver disease do further work up in form of USG abdomen and viral marker study. Your hemoglobin is mildly high, the proper workup should be done for that in form of full CBC and peripheral smear examination. Also check serum urea, creatinine for checking kidney profile. Investigate with these reports for primary work up. We can discuss further if needed then.
Patient's Query
Thank you doctor,
I have been tested for hemochromatosis and polycythemia vera with DNA and JAK 2 mutation in the past due to sometimes having high hemoglobin and hematocrit and all were negative. My hematocrit was the highest in normal range (50.0). This is the first time my liver enzymes have been high and I had them checked about six months ago. My kidney function tests were all normal including my creatinine and eGFR and BUN. My biggest concern is the B12. I do not take any supplements so I cannot find a reason it would be high. I have read that B12 that high can be a sign of cancer. I have also been having extreme sweating at random times throughout the day. I am having an abdominal ultrasound in two weeks. Is there any specific tests you suggest I ask my doctor to run also?
Hello,
Welcome back to icliniq.com.
Your ALT is high, so liver disease should be ruled out here. USG abdomen scan will be beneficial for that. Your workup done are as follows:
You have already investigated for primary polycythemia so the chance of primary polycythemia is not present here. Peripheral smear examination will be beneficial if any abnormal cells present. If no specific liver disease, kidney disease or myeloproliferative neoplasm present than in some cases bacterial overgrowth syndrome or defective utilization of B12 can be the possibility. So, if needed for further workup for defective B12 utilization can be done in form of urine methylmalonic acid estimation test or HoloTC test. Take care.
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Pathology
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