Hassan Mohammad Al-Shehri ID#2051040006

SCHILLING TEST
INDICATIONS
● Rule out pernicious anemia
● Identify malabsorption syndrome unrelated to IF deficiency
●Dual label Shilling test for pancreatic exocrine function

RADIOPHARMACEUTICAL
● *Co-B12 for first stage of test
● *Co-B12 + Intrinsic Factor Capsule for second stage

PROCEDURE
STAGE 1
● *Co-B12 capsule given orally, followed by IM injection of 1 mg nonradioactive Vitamin
B12. This non-radioactive Vitamine B12 is given to block B12 binding sites in the liver. If not
administered, essentially all the radioactive B12 localizes in the liver and little or none is
excreted in the urine, invalidating the test.
● Competent 24 hr urine collection
● Determination of % excretion in urine.
● If normal value obtained (>10%), test completed; no further action required.

STAGE 2
● If excretion from Part 1 Schilling Test is < 6%, then 3-5 days later another capsule of *Co-
B12 is administered orally along with a capsule containing 1 NF unit of Intrinsic Factor
● This capsule is then followed by IM injection of 1 mg non-radioactive Vitamin B12.
● Another competent 24 hr urine collection is then performed by patient and % excretion in
urine is determined.

INTERPRETATION: % Excretion

Part 1 Part 2 Interpretation

>10 ----- Normal
<6 <6 Malabsorption Syndrome unrelated to intrinsic factor
<6 6-12 Pernicious Anemia
LIMITATIONS
● False positives from incomplete urine collection
● False negatives if other radioisotopes "on board"
● False negatives if patient is on Vitamin B12 therapy

Dual label Shilling test for pancreatic exocrine function

Some specific proteins present in saliva, gastric juice, bile and intestinal secretions bind to
substantial amounts of dietary cobalamines and are called R binders. Pancreatic enzymes
partially degrade R binders and allow vitamin B12 to be transferred to intrinsic factor. A
malabsorption of vitamin B12 is, hence, seen in patients with chronic pancreatitis as
measured by shilling test. This malabsorption may, completely corrected by administration of
pancreatic enzyme preparations.

A dual label Shilling test for pancreatic exocrine function has been developed based on the
differential absorption of cobalamine bound to intrinsic factor and R protein. The result are
expressed as the ratio of R protein-cobalamine to intrinsic factor-cobalamine in 24 hours
urine. A low value for the ratio indicates exocrine pancreatic insufficiency.