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Vitamin B12 Deficiency Causes and Treatment

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About Course

B12 VITAMIN COURSE

An in-depth course on B12 for Nurses and Allied Health Professionals.

  • B12  Deficiency
  • Risk factors/groups
  • Common Symptoms
  • Causes of B12 deficiency
  • Obtaining Blood Tests
  • Diagnosis and reference ranges, testing
  • Factors affecting B12 diagnosis and treatment
  • Factors affecting absorption
  • B12 common side effects
  • Supplements
  • Contraindications and Precautions
  • Correct Administration and techniques
  • Injection sites
  • Prescribing

 

  • Policies and Procedures Advice
  • Hand Washing
  • Infection Control
  • Disposal of clinical waste
  • Needle stick injuries
  • Patient Assesment
  • Medication Management
  • Patient Record Keeping
  • Consent
  • Practice principles of safe sharps handling
  • Anaphylaxis

What Will You Learn?

  • This online course covers B12 deficiency, pernicious anaemia, diagnosis, treatment and management.

Course Content

B12 Deficiency Overview
Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cannot function properly. Red blood cells carry oxygen around the body using haemoglobin. Anaemia is the general term for having either fewer red blood cells than normal or having an abnormally low amount of haemoglobin in each red blood cell.

How much vitamin B12 daily is recommended
The amount of vitamin B12 needed each day depends on age. Average daily recommended amounts for different ages are listed below in micrograms (mcg). Life Stage Recommended Amount Birth to 6 months 0.4 mcg Infants 7–12 months 0.5 mcg Children 1–3 years 0.9 mcg Children 4–8 years 1.2 mcg Children 9–13 years 1.8 mcg Teens 14–18 years 2.4 mcg Adults 2.4 mcg Pregnant teens and women 2.6 mcg Breastfeeding teens and women 2.8 mcg

Risk Factors
Common risk factors for vitamin B12 deficiency: A diet low in vitamin B12 (without the regular use of over-the-counter preparations), for example, in people who: Follow a diet that excludes, or is low in, animal-source foods (such as a vegan diet, or diets excluding meat for religious beliefs) Do not consume food or drinks fortified with vitamin B12 Have an allergy to some foods such as eggs, milk or fish fFnd it difficult to buy or prepare food (for example, people who have dementia or frailty, or those with mental health conditions) Find it difficult to obtain or afford foods rich in vitamin B12 (for example, people on low income) Have a restricted diet (for example, because of an eating disorder) Family history of vitamin B12 deficiency or an autoimmune condition Health conditions: Atrophic gastritis affecting the gastric body Coeliac disease or another autoimmune condition (such as thyroid disease, Sjögren's syndrome or type 1 diabetes) Medicines: Colchicine H2-receptor antagonists Metformin (see the MHRA safety advice on metformin and reduced vitamin B12) Phenobarbital Pregabalin Primidone Proton pump inhibitors Topiramate Previous abdominal or pelvic radiotherapy Previous gastrointestinal surgery: Many bariatric operations (for example, Roux-en-Y gastric bypass or sleeve gastrectomy) Gastrectomy or terminal ileal resection Recreational nitrous oxide use.

Common Symptoms
Common symptoms and signs of vitamin B12 deficiency abnormal findings on a blood count such as anaemia or macrocytosis Cognitive difficulties such as difficulty concentrating or short-term memory loss (sometimes described as 'brain fog'), which can also be Symptoms of delirium or dementia Eyesight problems related to optic nerve dysfunction: Blurred vision Optic atrophy Visual field loss (scotoma)glossitis Neurological or mobility problems related to peripheral neuropathy, or to central nervous system disease including myelopathy (spinal cord disease): Balance issues and falls caused by impaired proprioception (the ability to sense movement, action and location) and linked to sensory ataxia (which may have been caused by spinal cord damage) Impaired gait Pins and needles or numbness (paraesthesia) Symptoms or signs of anaemia that suggest iron treatment is not working properly during pregnancy or breastfeeding Unexplained fatigue.

Folate and B12
Folate and B12 should always be assessed together due to the close relationship of metabolism and overlap of clinical symptoms deficiency causes. Indications for folate assessment: 1. Unexplained anaemia/macrocytic anaemia/megaloblastic anaemia 2. Excess alcohol intake especially with coexisting liver disease 3. Exfoliative skin diseases 4. Post gastric and bariatric surgery Indications for folate supplementation without assessment of folate levels are: 1. Pregnancy 2. Haemolytic anaemia – autoimmune haemolysis, red cell membrane disorders and haemoglobinopathies. Hull and East Riding Prescribing Committee B12 & Folate Guidelines Apprived by HERPC: January 2015. Updated April 2018 Review: April 2021 Folate should be considered to be low if the level is <3 micrograms/L. Below this level megaloblastic anaemia is more common.

Raised Vitamin B12
Raised B12 Vitamin B12 does not accumulate to toxic levels. Raised B12 s associated with underlying medical conditions including liver disease, renal failure and myeloproliferative disorders (polycythaemia, chronic myeloid leukaemias and hypereosinophilic syndrome). Liver disease causes release of cobalamin from stores into the circulation, renal disease reduces its excretion and cMPDs increase the number of B12 containing red and white cells. Raised B12 should lead to assessment for the above conditions and referral to the appropriate specialty.

What foods provide vitamin B12?

Causes of B12 Deficiency

Blood Testing

Symptoms and Complications

Explaining starting Treatment to the Patient
Explain to people starting treatment with vitamin B12 replacement: That response to treatment can vary and depends on the cause of the vitamin B12 deficiency That their symptoms could start to improve within 2 weeks, but this may take up to 3 months That it can take much longer for symptoms to disappear altogether, and that although their symptoms could get worse initially during treatment, this should improve When to seek medical help (without waiting for any scheduled appointments) if their symptoms have not improved, get worse or return, or they get new symptoms, after starting treatment.

Treatment

Monitoring Patients

References
Devalia, V. et al. (2014). Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British Journal of Hameatology, 496-513. Remacha, A. et al. (2003). Vitamin B-12 metabolism in HIV-infected patients in the age of highly active antiretroviral therapy: role of homocysteine in assessing vitamin B-12 status. Americal Journal of Clinical Nutrition, 420–4 A. Fletcher, S. Holding, (2021) Consultation process: Blood Sciences Department Ratified by: HERPC: Updated May 2018, May 2021

Policy and Procedures

Patient Leaflet