Erythrocyte transketolase activity is raised in megaloblastic anaemia due to vitamin B12 deficiency and inversely related to haemoglobin concentration. It si usually normal in cases of megaloblastic anaemia due to folate deficiency though sufficient exceptions occur to invalidate the use of red cell transketolase assay in differentiation of vitamin B12 from folate deficiency.There is no evidence that altered thiamine metabolism is a factor in the disturbance of pyruvate metabolism that occurs in vitamin B12 deficiency, nor that thiamine deficiency is involved in the commonly associated neuropsychiatric disorder.Erythrocyte transketolase activity is normal in untreated iron deficiency anaemia, aplastic anaemia, polycythaemia, chronic myeloid and lymphatic leukaemia, erythroleukaemia and non-anaemic patients with glucose-6-phosphate deficiency. Increased red cell transketolase activity is seen in iron deficiency anaemia responding to treatment, hereditary spherocytosis and occasionally in patients with an autoimmune haemolytic anaemia or acute leukaemia.

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