This form converts to hydroxocobalamin and then to methylcobalamin and adenosylcobalamin in the body. It may cut down the percentage of indeterminate results, particularly in patients over the age of 65 years. Oral vitamin B 12 versus intramuscular vitamin B 12 for vitamin B 12 deficiency. In mild vitamin B 12 deficiency, we recommend repeat measurements of serum vitamin B 12, homocysteine, and methylmalonic acid levels two to three months after initiating treatment. Cobalamin deficiency In patients with classical megaloblastic anaemia, the presence of a low serum cobalamin level and objective assessment of response in terms of the rise in haemoglobin concentration clearly outlines the treatment pathway.
Treatment for anemia related to vitamin C deficiency is with vitamin C tablets. Similarly, an association between elevated homocysteine levels and cognitive impairment has been noted, but subsequent vitamin B 12 replacement does not have preventive or therapeutic benefit. How I treat cobalamin vitamin B 12 deficiency. Methylmalonic acid and homocysteine levels may help to diagnose vitamin B12 deficiency at an early, asymptomatic state. All three forms have completely different functions in the body and are required for divergent processes. With the redefinitions shown in , the risk of misdiagnosis jumps to 40. Transfusion should otherwise be avoided, unless dictated by clinical, not numerical, considerations.
Current concepts in cobalamin deficiency. A low intake or poor absorption of folate leads to a low serum folate level, which then leads to low tissue levels. This effect increased with duration of therapy, and patients had an unclear prophylactic supplementation response. Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain. B 12 deficiency: a look beyond pernicious anemia.
In the second reaction, homocysteine is converted to methionine by using vitamin B 12 and folic acid as cofactors. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. It is also used in the treatment of Leber's optic atrophy. Treatment with high-dose oral vitamin B12 therapy may be as effective as intramuscular vitamin B12 therapy. Early diagnosis is critical in preventing and halting the progression of neurologic disorders such as peripheral neuropathy and dementia. Quality of evidence The quality of evidence is graded as high A , moderate B or low C.
Lifelong therapy should be continued in the presence of an objective clinical response Grade 2A. Patients with evidence of vitamin B 12 deficiency and chronic gastrointestinal symptoms such as dyspepsia, recurrent peptic ulcer disease, or diarrhea may warrant evaluation for such entities as Whipple's disease a rare bacterial infection that impairs absorption , Zollinger-Ellison syndrome gastrinoma causing peptic ulcer and diarrhea , or Crohn's disease. It is also advised that smokers do not use cyanocobalamin. Please consult the website at for updates. Update on vitamin B 12 deficiency.
This possibility becomes especially important when considering vitamin replacement therapy. A multicenter trial of 390 patients with diabetes mellitus receiving insulin therapy who were randomized to receive metformin, 850 mg three times daily, or placebo assessed the risk of vitamin B 12 deficiency and low vitamin B 12 levels over four years. However, any abnormality discovered in a medical encounter must be pursued to clinically satisfactory resolution. The level of this substance is higher in people with vitamin B-12 deficiency. True cobalamin deficiency, with significant clinical problems, is considered to be rare in infants in developed countries and limited data exists on its prevalence. Treating vitamin B12 deficiency anaemia Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12. All medically initiated encounters mandate this search.
Foodstuffs rich in B 12 include meat, liver, bovril, fish, cereals, eggs, cheese, tofu and milk. Environmental and nutritional factors in disease. Breastfeeding is associated with a low cobalamin status Hay et al, in asymptomatic infants, particularly with prolonged exclusive breast feeding of 4 months or longer duration, in mothers who are replete of cobalamin levels Greibe et al,. A roughly inverse relationship often exists between hematologic and neurologic deficits. Note that neurological presentation of cobalamin deficiency may occur despite normal haematological indices Features of malabsorption Ask about pale stool, bowel movements at night, abdominal pain, mouth or perianal ulceration. In this test, you first ingest a tiny amount of radioactive vitamin B-12. Only in rare disorders of cellular utilization do consequences appear rapidly.
Because crystalline formulations are better absorbed than naturally occurring vitamin B 12, patients older than 50 years should consume foods fortified with vitamin B 12 and vitamin B 12 supplements, rather than attempting to get vitamin B 12 strictly from dietary sources. In all other cases, oral administrations of normal doses of vitamin B12 are usually sufficient. Oral therapy may be suitable and acceptable provided appropriate doses are taken and compliance is not an issue. Omeprazole therapy causes malabsorption of cyanocobalamin vitamin B 12. Use of vitamin B 12 in patients with elevated serum homocysteine levels and cardiovascular disease does not reduce the risk of myocardial infarction or stroke, or alter cognitive decline.
The potential has grown for misattributing cobalamin-unrelated clinical findings to clinically irrelevant biochemical abnormalities. If the reasons for an absorption disorder are unclear, the search for the cause begins at the same time as supplementation. Data Sources: A PubMed search was completed in Clinical Queries using the key terms vitamin B 12, cobalamin, deficiency, and treatment. The website will also show the date the guideline was last reviewed. A 2005 Cochrane review involving 108 patients with vitamin B 12 deficiency found that high-dose oral replacement 1 mg to 2 mg per day was as effective as parenteral administration for correcting anemia and neurologic symptoms. People who find it difficult to get enough vitamin B12 in their diets, such as those following a , may need vitamin B12 tablets for life. Some patients require a combination of forms.
Treatment of folate deficiency The dose of folic acid necessary for treatment depends on the cause of the deficiency. Prevalence of cobalamin deficiency in the Framingham elderly population. One was the premature medicalization of mild, biochemical deficiency, followed by loosening of its diagnostic criteria. Effects of homocysteine-lowering with folic acid plus vitamin B 12 vs placebo on mortality and major morbidity in myocardial infarction survivors: a randomized trial. High dose oral cobalamin would be a reasonable alternative as maintenance in patients unable to tolerate intramuscular injections provided there is good compliance with treatment Stabler,.