This article was published in  No 2 of The Rondel (Jan 31, 2000)

Methylmalonic acid and vitamin B12

I was lucky, when I was examined in internal medicine in Lund 40 years ago. My test patient had pernicious anemia with all symptoms and signs of the text-book. The blood picture was unmistakable. Advanced perniciosa was common in that period. As student in the department of surgery, I assisted in surgical resections of the stomach according to Billroth, which produced pernicious anemia in the future of the patient. A few years later, in the 1960´ies, I encountered many cases of pernicious anemia in Kristianstad. Their vitamin B12 deficiency was mainly due to infestation with tapeworm of fish from the Ivö Lake. Serum cobalamin was then determined by the green algae Euglena Gracilis. The technique had both potency and weaknesses. We thus tried to determine methylmalonic acid MMA) in urine as a tool in the laboratory diagnosis of vitamin B12 deficiency. Twelve healthy persons excreted less than 5 mg MMA daily, and so did 10 patients with serum cobalamin >70 pg/mL, as measured with the Euglena method. In contrast, out of 21 patients with serum cobalamin <70 pg/mL, 18 had elevated levels of urine MMA. We applied our observations in approximately 100 patients in Skåne. The possibility to use serum MMA in the diagnosis of vitamin B12 deficiency was generally acknowledged several decades later.

Reference

Holmberg CG, Jönemar B, Nordén Å, Stålberg K-G, Ktryding N. Methylmalonic acid excretion and serum vitamin B12. Scand J Haematol 1966; 2:399-403.

Updated januari 29, 2001