Approach to hihg vitamin b 12


Q: 64 year healthy male with no symptoms 70 kg weight, vegeterian, non alcoholic, non smoker, with history of controlled diabetes on oral medication , underwent routine liver function test[ normal] , vitamin B 12[ high], D3 [ low]and calcium leve[ normal - 9]l, uric acid[ 3.92].
Report - vitamin B12- greater than2000picogram/ml[ normal range- 187-883],
total bilirubin - .72, direct- .14, indirect .58, sgot - 26, sgpt 21 , Alk phosphate - 143
creatinine- .95 mg/dl, BUN- 30 mg/dl.
total protein - 7.2 gm/dl, albumin 4gm/dl, globulin 3.2gm/dl, A/G ratio1.25,
sodium - 140 meq/l,
potassium- 4.75meq/l ,
chloride- 103meq/l,
fasting blood sugar - 112mg/dl,
Do u suggest me further approach to high vitamin B12 to rule out malignancy like peripheral blood smear-for hematologic malignancy, USG abdomen, tumar maker - CEA, AFP, PSA.

Symptoms:  Asymptomatic

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