Personalising laboratory medicine in the 'real world': Assessing clinical utility, by clinical indication, of serum total B 12 and Active-B 12 ® (holotranscobalamin) in the diagnosis of vitamin B 12 deficiency

Assessing the pre- and post-test probability of disease in the context of routine health care is challenging. We wished to study how test performance parameters relating to clinical utility vary by clinical indication in a 'real-world' setting. The diagnostic accuracy of serum total B and Active-B ® (holotranscobalamin) was evaluated in a primary care population, using serum methylmalonic acid as the reference standard. We used electronic requesting to establish the clinical indication for each request. Routine requests from primary care for serum total B were included if creatinine was also measured and estimated glomerular filtration rate was at least 60 mL/min/1.73 m . Clinical indications included peripheral neuropathy ( = 168), anaemia ( = 168), cognitive decline ( = 125), suspected dietary deficiency ( = 76), other ( = 362). For peripheral neuropathy, the area under the receiver operator curve ± 95% confidence interval (AUC ± CI) was 0.63 (0.54-0.71) ( = 0.002) for total B and 0.68 (0.60-0.77) (