Vitamin B12.


Vitamin deficiency anaemia usually develops slowly over several months to years.

Signs and symptoms may be subtle at first but usually increase as the deficiency worsens.

These may include:

  • Fatigue
  • Shortness of breath
  • Dizziness
  • Pale or yellowish skin
  • Irregular heartbeats
  • Weight loss
  • Numbness or tingling in the hands and feet
  • Muscle weakness
  • Personality changes
  • Unsteady movements
  • Mental confusion or forgetfulness

 

Normal MCV 76-96.

Normal B12 >120ng/l.

 

If not anaemic , due to alcohol.  if anaemic due to B12 or folate def.

 

 

Causes of low B12.

  • None in diet – strict vegan, ASD, poverty, alcoholism etc
  • Pernicious anaemia – Intrinsic Factor def.
  • Post gastrectomy – lack of IF.
  • Terminal ileum disease - colitis, surgery
  • Meds – metformin, AEDs, colchicine, PPIs.

If have B12 def. it is wise to refer to ensure that Pernicious anaemia is ruled out  - as will need regular OGDs.

 

 

 

Pernicious anaemia.

Autoimmune disorder against parietal cells in stomach, no IF produced ,hence B12 not absorbed.

Linked to other AI – Hashimotos,DM,Addisons.

Rare under 40.

F>M.

Atrophic gastritis.

Gastric cancer

Anti parietal cell antibodies.

 

 

 

 

 

Treatment.

IM Hydoxycobalamin every 2 days for 5 doses, then every 3/12.cannot give too much as water soluble.

Usually need iron also.

Regular OGD not justified.

 

Fear of diagnosing folate deficiency and treating, but pathology really being B12 def and resultant neurological decompensation.