Vitamin B12 Deficiency
(Vitamin B12 Dependency; Macrocytic Achylic Anemia)
|Red Blood Cells|
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- Removal of part of the small intestine or stomach
- Increased age and inadequate absorption of B12
Long-term use of certain acid-reducing stomach medications:
- H2 blockers
- Proton pump inhibitors
- Atrophic gastritis (inflammation of the stomach) due to:
- Disorders affecting vitamin absorption:
Inadequate intake of vitamin B12
- Long-term veganism (nonconsumption of animal products) or vegetarianism
- Breastfed infants of vegan or vegetarian mothers
- Poor nutrition
- Inadequate nutrition for a pregnant woman
- Chronic alcohol abuse
- Chronic intestinal conditions that lead to malabsorption
- Inflammation of the intestine due to radiation treatment
Increased need of vitamin B12:
- Intestinal parasites
- Other types of anemia
- Methylmalonic aciduria
Use of certain drugs:
- Biguanides for diabetes
- Acid-reducing medications
- Strict vegan or vegetarian diet
- Sensation of pins and needles in feet or hands
- Stinging sensation on the tongue or smooth red tongue
- Substantial weight loss
- Altered sense of taste
- Impaired sense of balance, especially in the dark
- Inability to sense vibrations in feet or legs
- Lightheadedness when changing to standing position
- Rapid heart rate
- Complete blood count (CBC)—a count of the number of red and white blood cells in a blood sample
- Vitamin B12 level—a test that measures the amount of vitamin B12 in the blood
- Methylmalonic acid (MMA) level
- Homocysteine level
- Schilling test—a test in which a small amount of radiation is used to assess the absorption of vitamin B12 deficiency
- Folate level—a measurement of the amount of a B vitamin called folic acid
- Intrinsic factor antibodies—this test helps to determine pernicious anemia as the cause of symptoms
Oral Vitamin B12 Supplement
Vitamin B12 Injections
Treatment With Antibiotics
Intranasal Vitamin B12
- Avoid long-term over-consumption of alcohol.
- As directed by your doctor, take a daily supplement containing vitamin B12.
- As directed by your doctor, give vitamin B12 to your breastfed baby if you are a vegan or vegetarian.
- Undergo testing if your doctor suspects you have a bacterial infection.
Have your doctor monitor your health closely if you are taking certain medications:
- Acid-reducing medications
Family Doctor—American Academy of Family Physicians http://familydoctor.org
National Institutes of Health Office of Dietary Supplements http://ods.od.nih.gov
College of Family Physicians of Canada http://www.cfpc.ca
Health Canada http://www.hc-sc.gc.ca
Pernicious anemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 9, 2013. Accessed December 22, 2014.
Vitamin B12. American Association of Clinical Chemistry website. Available at: http://www.labtestsonline.org/understanding/analytes/vitamin%5Fb12/glance.html. Updated May 27, 2014. Accessed December 22, 2014.
Vitamin B12. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 5, 2013. Accessed December 22, 2014.
Vitamin B12 deficiency. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 23, 2014. Accessed December 22, 2014.
- Reviewer: Michael Woods, MD
- Review Date: 12/2014 -
- Update Date: 12/20/2014 -