Routine determination of serum methylmalonic acid and plasma total homocysteine in Norway.

OBJECTIVE To study the total number of combined analyses of methylmalonic acid (MMA) and total plasma homocysteine (tHcy) carried out during February 1998 at the Central Laboratory of Haukeland University Hospital. METHODS Laboratory data and requester comments of 2917 subjects in whom MMA was requested during February 1998, were retrieved from the laboratory information system (LIS). In 2520 cases, the results from the combined analyses of MMA and tHcy were available. Requester comments were registered in the LIS in 1084 cases. Results from additional laboratory analyses were accessible in about 10%, of cases. RESULTS General practitioners requested MMA and tHcy on three main indications, i.e. low cobalamin, "control" and neurological symptoms. Metabolites were requested in twice as many women than men. Furthermore, MMA was requested in younger age groups of women compared with men. Plasma tHcy and MMA showed positive correlations with age and serum creatinine, and tHcy was generally 1-2 micromol/L higher in men than in premenopausal women. In cobalamin- (serum cobalamin > 300 pmol/L) and/or folate- (serum folate > 10 nmol/L) replete subjects, the average difference in MMA or tHcy according to the highest and lowest creatinine quartiles was 0.08 and 5-6 micromol/L, respectively. Different combinations of MMA and tHcy were evaluated by using a 5 x 5 matrix of predefined concentration intervals. Based on this matrix, cobalamin and folate deficiency could be excluded or the likely diagnoses proposed in 76% of cases. Cobalamin deficiency or folate deficiency was likely in about 7% and 12% of the subjects investigated, respectively. CONCLUSIONS A combined analysis of MMA and tHcy provides complementary diagnostic information. When interpreting MMA and tHcy values, age, gender and renal function in particular must be taken into account. Typical combinations of MMA and tHcy concentration intervals could be proposed, which could either exclude deficiency or indicate likely diagnoses and/or influence of confounders.