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    Schilling Test Interpretation

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    kyle sway
    The document discusses the Schilling test, which is used to diagnose vitamin B12 deficiency. It has two stages: [1] Stage 1 tests for absorption of radioactive B12 in the terminal ileum. Abnormal results could indicate defects in absorption or a lack of intrinsic factor. [2] Stage 2 administers intrinsic factor and tests absorption again. Improved results point to intrinsic factor deficiency, while still abnormal results indicate ileal absorption defects. The test is being replaced by other tests like serum B12 levels and markers like homocysteine and methylmalonic acid. Pernicious anemia is confirmed by testing for intrinsic factor autoantibodies or low gastrin levels.

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    Schilling Test Interpretation

    Uploaded by

    kyle sway
    69 views3 pages
    The document discusses the Schilling test, which is used to diagnose vitamin B12 deficiency. It has two stages: [1] Stage 1 tests for absorption of radioactive B12 in the terminal ileum. Abnormal results could indicate defects in absorption or a lack of intrinsic factor. [2] Stage 2 administers intrinsic factor and tests absorption again. Improved results point to intrinsic factor deficiency, while still abnormal results indicate ileal absorption defects. The test is being replaced by other tests like serum B12 levels and markers like homocysteine and methylmalonic acid. Pernicious anemia is confirmed by testing for intrinsic factor autoantibodies or low gastrin levels.

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    Schilling test interpretation

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    The document discusses the Schilling test, which is used to diagnose vitamin B12 deficiency. It has two stages: [1] Stage 1 tests for absorption of radioactive B12 in the terminal ileum. Abnormal results could indicate defects in absorption or a lack of intrinsic factor. [2] Stage 2 administers intrinsic factor and tests absorption again. Improved results point to intrinsic factor deficiency, while still abnormal results indicate ileal absorption defects. The test is being replaced by other tests like serum B12 levels and markers like homocysteine and methylmalonic acid. Pernicious anemia is confirmed by testing for intrinsic factor autoantibodies or low gastrin levels.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    69 views3 pages

    Schilling Test Interpretation

    Uploaded by

    kyle sway
    The document discusses the Schilling test, which is used to diagnose vitamin B12 deficiency. It has two stages: [1] Stage 1 tests for absorption of radioactive B12 in the terminal ileum. Abnormal results could indicate defects in absorption or a lack of intrinsic factor. [2] Stage 2 administers intrinsic factor and tests absorption again. Improved results point to intrinsic factor deficiency, while still abnormal results indicate ileal absorption defects. The test is being replaced by other tests like serum B12 levels and markers like homocysteine and methylmalonic acid. Pernicious anemia is confirmed by testing for intrinsic factor autoantibodies or low gastrin levels.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Schillling test

    Potential Diagnosis

    During Stage 1, a healthy person will be able to absorb the administered radioactive B12 in their
    terminal ileum. It will then be excreted in the urine.

    If there are any defects with the cubam receptor at the terminal ileum, the result will show a low level of
    labeled cobalamin in urine as it will remain in the intestines and is likely to be excreted in feces. A defect
    associated with low levels of an intrinsic factor will also produce a similar abnormal result.

    Patients with an abnormally low level of cobalamin in the urine in stage 1 usually undergo stage 2. If
    stage 2 shows a normal level of excreted vitamin B12, it means that the patient has low intrinsic factor
    levels, and one possible cause is pernicious anemia. If the test still indicates a low level of vitamin B12 in
    the urine, it means that the patient has a poor intestinal absorption of cobalamin. Further tests should
    be done to assess the cause of malabsorption that can include Crohn’s disease, small bowel bacterial
    overgrowth syndrome, and infection by Diphyllobothrium latum.

    Normal and Critical findings

    Stage 1

    A normal patient will show a normal level of cobalamin in urine upon administration of the oral dose. If
    the urine level is abnormal, it can be from either an absorption defect in the terminal ileum or a lack of
    intrinsic factor.

    Excreting 8% to 40% of the radioactive vitamin B12 in the urine within 24 hours is considered a normal
    finding. The values, however, may fluctuate between laboratories.

    Stage 2

    If the abnormal result of stage 1 improves with intrinsic factor administration, it means that the patient
    has intrinsic factor deficiency. If the patient still has a low urine level of cobalamin, then there is an
    absorption defect in the terminal ileum, and further tests should be done to investigate.
    Additionally

    Currently, the Schilling test is not readily available in most countries to diagnose vitamin B12 deficiency.
    Labeled cobalamine can no longer be obtained. No replacement test provides the same information, but
    the level of serum vitamin B12 is now a test of choice in many hospitals. Patients with >300 pg/mL are
    normal, 200 to 300 pg/mL borderline and less than 200 pg/mL classified as deficient in vitamin B12. The
    levels of homocysteine and methylmalonic acid are also usually investigated and elevated in those
    patients. Other options are the CobaSorb test that measures changes in circulating holo-transcobalamin
    before and after B-12 administration, and the 14C-labeled B-12 test for quantitative measurement of
    absorption of a low-dose radioactive tracer.

    Patients with low levels of cobalamin are tested for autoantibodies to intrinsic factor with an
    immunoassay. Pernicious anemia is usually caused by the presence of autoantibodies against parietal
    cells that make intrinsic factors, and the presence of those autoantibodies is considered as a
    confirmatory test. The immunoassay has low sensitivity and specificity, and if the physician suspects
    pernicious anemia and has a negative immunoassay, it is advised to measure gastrin levels. Since
    parietal cells are also responsible for the production of gastrin level, patients with pernicious anemia will
    also have a low gastrin level.

    References:

    Rao SK,Schilling TF,Sequist TD, Challenges in the management of positive fecal occult blood tests.
    Journal of general internal medicine. 2009 Mar;

    Duerksen DR,Fallows G,Bernstein CN, Vitamin B12 malabsorption in patients with limited ileal resection.
    Nutrition (Burbank, Los Angeles County, Calif.). 2006 Nov-Dec

    https://www.statpearls.com/articlelibrary/viewarticle/28752/

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