Vitamin B12/folate deficiency

Question 1

What is B12 used for

Answer 1

RBC development
maintenance of nervous system

Question 2

What are causes of vitamin B12 deficiency

Answer 2

pernicious anemia - most common

post gastrectomy

vegan/poor diet

disorders of terminal ileum
- Crohns
-Coeliac- folate deficiency

metformin - VERY RARE

Question 3

How may someone with vit B12/folate deficiency present

Answer 3

macrocytic anemia
– fatigue , poor concentration, pallor

• sore tongue and mouth

–neurological symptoms - doral column affected first

-neuropsychiatric symptoms

Question 4

What investigations are required

Answer 4

Bloods
- anaemia, low B12, low folate

• thrombocytopenia

Blood film
- hypersegmented neutrophils/polymorphs

Question 5

When is urgent referral needed

Answer 5

patient has loss of cutaneous sensation ,
muscle weakness,
optic neuropathy ,
psychiatric disturbance, symmetrical neuropathy
urinary incontinence
faecal incontinence

Question 6

What is management for Vitamin b12/folate deficiency if no neurological involvement

Answer 6

1mg of IM hydroxocobalamin 3 times each week for 2 weeks
then once every 3 months

folic acid tablets

Question 7

If folic acid deficient what do you need to treat first

Answer 7

B12 deficiency

to avoid precipitating subacute combined degeneration of the cord