Interesting Case:

Pt is a 65yo female seen in consult for mild thrombocytopenia and mild leukopenia.  PMHx otherwise significant only for severe depression.  Lab work up significant for Vit B12 ~800, Folic Acid >20, MethylMalonic Acid Level initially 22,000 nmol/l (ULN 376) and has been increasing over the past 6 weeks and is now appx 28,000 nmol/L with every other laboratory parameter within normal limits.  Has anyone else seen this before or can advise on evaluation of acquired methylmalonic acidemia?