The Schilling test was a medical investigation used for patients with vitamin B (cobalamin) deficiency. The purpose of the test was to determine how well a patient is able to absorb B12 from their intestinal tract. The test is now considered obsolete and is rarely performed, and is no longer available at many medical centers. It is named for Robert F. Schilling. Process The Schilling test has multiple stages. As noted below, it can be done at any time after vitamin B supplementation and body store replacement, and some clinicians recommend that in severe deficiency cases, at least several weeks of vitamin repletion be done before the test (more than one B shot, and also oral folic acid), in order to ensure that impaired absorption of B (with or without intrinsic factor) is not occurring due to damage to the intestinal mucosa from the B and folate deficiency themselves. Stage 1: oral vitamin B plus intramuscular vitamin B12 (without IF) In the first part of the test, the patient is given radiolabeled vitamin B to drink or eat. The most commonly used radiolabels are 57Co and 58Co. An intramuscular injection of unlabeled vitamin B is given an hour later. This is not enough to replete or saturate body stores of B. The purpose of the single injection is to temporarily saturate B receptors in the liver with enough normal vitamin B to prevent radioactive vitamin B binding in body tissues (especially in the liver), so that if absorbed from the G.I. tract, it will pass into the urine. The patient's urine is then collected over the next 24 hours to assess the absorption. Normally, the ingested radiolabeled vitamin B will be absorbed into the body. Since the body already has liver receptors for transcobalamin/vitamin B saturated by the injection, much of the ingested vitamin B will be excreted in the urine. A normal result shows at least 10% of the radiolabeled vitamin B in the urine over the first 24 hours. In patients with pernicious anemia or with deficiency due to impaired absorption, less than 10% of the radiolabeled vitamin B is detected. The normal test will result in a higher amount of the radiolabeled cobalamin in the urine because it would have been absorbed by the intestinal epithelium, but passed into the urine because all hepatic B12 receptors were occupied. An abnormal result is caused by less of the