What are the causes of elevated vitamin B12 levels?

Elevated vitamin B12 levels may be caused by supplements, liver disease, kidney disease or myeloid malignancies. One potential benign cause of such elevations is megalobin, a complex formed by vitamin B12, trans-cobalamin and immunoglobulin. Although this complex is biologically inactive, it can still lead to elevated plasma vitamin B12 levels due to its reduced clearance. Persistent and unexplained elevated vitamin B12 levels may lead to patients undergoing invasive diagnostic procedures, including bone marrow biopsy. However, giant vitamin B12 can be detected using the polyethylene glycol precipitation method, thereby avoiding unnecessary diagnostic procedures, including bone marrow aspiration.

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