title: An IgG complexed form of vitamin B12 is a common cause of elevated serum concentrations.
abstract: OBJECTIVE
  To report detailed investigations in a case of elevated serum B(12) due to the presence of an IgG-B(12) complex, to determine the prevalence of this phenomenon and to review the literature.
  
  
  METHODS
  431 samples with elevated B(12) (median 1250 ng/L, range 901-114,480 ng/L) were treated with polyethylene glycol to precipitate immunoglobulin complexes. Samples with >50% of precipitable B(12) (PPB(12)) were further investigated by protein G adsorption, gel filtration chromatography and measurement of B(12) on different analytical platforms.
  
  
  RESULTS
  Median PPB(12) was 22.6%, but in 35 samples (8.1%), median PPB(12) was more than 50%. Investigation of 27 of these samples with protein G-Sepharose confirmed the presence of an IgG-B(12) complex in 24, and in 15 cases, B(12) fell to within the reference range. After treatment of serum with reagents releasing B(12) from binding proteins, immunoreactivity co-eluted with free B(12). Immunoreactivity of the IgG-bound form of B(12) was confirmed using five B(12) assays in common use in the UK.
  
  
  CONCLUSIONS
  At least 8% of samples with elevated vitamin B(12) contain an immunoglobulin complexed form of circulating B(12); this possibility should be considered in the interpretation of results.
authors.affiliation: Department of Clinical Biochemistry, Derriford Hospital, Plymouth PL6 8DH, UK. jinny.jeffery@phnt.swest.nhs.uk
authors.forename: Jinny
authors.initials: J
authors.lastname: Jeffery
authors.forename: Helen
authors.initials: H
authors.lastname: Millar
authors.forename: Paul
authors.initials: P
authors.lastname: Mackenzie
authors.forename: Michael
authors.initials: M
authors.lastname: Fahie-Wilson
authors.forename: Malcolm
authors.initials: M
authors.lastname: Hamilton
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Ayling
mesh_terms: D001323:Autoantibodies / Q000097:blood; D001681:Biological Assay / Q000379:methods; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008875:Middle Aged; D046912:Multiprotein Complexes / Q000097:blood*; D011092:Polyethylene Glycols / Q000378:metabolism; D012196:Review Literature as Topic; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000097:blood*; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000097:blood*
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D046912:Multiprotein Complexes; D014803:Vitamin B Complex; D011092:Polyethylene Glycols; D014805:Vitamin B 12