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5 Using elevated metabolite levels (ie, serum methylmalonic acid [MMA] or homocysteine [Hcy]) to define deficiency, the screening serum B 12 cutoff used in many diagnostic algorithms has been raised to 250 pg/mL to 300 pg/mL to provide greater sensitivity

Similarly, AT21 Ant (anterior) and AT21 Post (posterior), from another patient, displayed an oxidative and mixed metabolic phenotype, respectively (Fig