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Epidemiology: High levels of vitamin B12 were found in: Causes: Excessive supplementation (a direct increase in plasma vitamin B12 by excess intake or administration) Increased release of vitamin B12 from tissue stores (liberation from an internal reservoir): Solid tumors (especially hepatic or hematologic malignancies) Liver metastases Increased binding proteins: 7 Excess production: Liver disease (e.g., hepatitis, cirrhosis, hepatocellular carcinoma) damaged hepatocytes release haptocorrin (transcobalamin I) and B12 into circulation Myeloproliferative disorders these increase granulocyte production, which leads to more haptocorrin (transcobalamin I/III), a B12-binding protein produced by proliferating myeloid cells

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If it looks discolored, stuck to the sides, or has an unusual appearance, the vial may have been compromised during shipping or storage

1,2 Serum vitamin B 12 levels may be artificially elevated in patients with alcoholism, liver disease, or cancer because of decreased hepatic clearance of transport proteins and resultant higher circulating levels of vitamin B 12