Interpretation of B12 Status After a Roux-en-Y Gastric Bypass | Bariatric Surgery | JN Learning | AMA Ed Hub [Skip to Content]
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Interpretation of Vitamin B12 Status After a Roux-en-Y Gastric Bypass

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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Article Information

Corresponding Author: Sameer B. Murali, MD, MSHS, Southern California Permanente Medical Group, 17296 Slover Ave, Fontana, CA 92337 (sameer.b.murali@kp.org).

Published Online: July 26, 2019. doi:10.1001/jama.2017.18945

Conflict of Interest Disclosures: None reported.

References
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Aills  L, Blankenship  J, Buffington  C, Furtado  M, Parrott  J; Allied Health Sciences Section Ad Hoc Nutrition Committee.  ASMBS allied health nutritional guidelines for the surgical weight loss patient.  Surg Obes Relat Dis. 2008;4(5)(suppl):S73-S108. doi:10.1016/j.soard.2008.03.002PubMedGoogle ScholarCrossref
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Devalia  V, Hamilton  MS, Molloy  AM; British Committee for Standards in Haematology.  Guidelines for the diagnosis and treatment of cobalamin and folate disorders.  Br J Haematol. 2014;166(4):496-513. doi:10.1111/bjh.12959PubMedGoogle ScholarCrossref
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Lindenbaum  J, Healton  EB, Savage  DG,  et al.  Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis.  N Engl J Med. 1988;318(26):1720-1728. doi:10.1056/NEJM198806303182604PubMedGoogle ScholarCrossref
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Stabler  SP, Allen  RH, Savage  DG, Lindenbaum  J.  Clinical spectrum and diagnosis of cobalamin deficiency.  Blood. 1990;76(5):871-881.PubMedGoogle Scholar
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Clinical laboratory fee schedule. Centers for Medicare & Medicaid Services website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/index.html. Updated February 27, 2019. Accessed July 18, 2019.
6.
Backman  O, Stockeld  D, Rasmussen  F, Näslund  E, Marsk  R.  Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery.  Br J Surg. 2016;103(10):1336-1342. doi:10.1002/bjs.10258PubMedGoogle ScholarCrossref
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Heber  D, Greenway  FL, Kaplan  LM, Livingston  E, Salvador  J, Still  C; Endocrine Society.  Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline.  J Clin Endocrinol Metab. 2010;95(11):4823-4843. doi:10.1210/jc.2009-2128PubMedGoogle ScholarCrossref
8.
Brolin  RE, Gorman  JH, Gorman  RC,  et al.  Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass?  J Gastrointest Surg. 1998;2(5):436-442. doi:10.1016/S1091-255X(98)80034-6PubMedGoogle ScholarCrossref
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