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A patient may have: Serum B12 → Normal / High ⬇️ But cellular utilization may still be inadequate ⬇️ Functional B12 deficiency may be suspected When clinical findings or laboratory results suggest B12 deficiency despite a normal/high serum B12, additional markers can provide a better picture: 🧪 Methylmalonic Acid (MMA) ↑ 🧪 Homocysteine ↑ 🩸 CBC & MCV 🔬 Clinical correlation ⚠️ An important laboratory message High Serum B12 ≠ Guaranteed Cellular Sufficiency Serum B12 measures circulating vitamin B12, but it does not necessarily tell us how effectively the vitamin is being utilized by tissues