{"id":24957,"date":"2025-07-30T15:16:11","date_gmt":"2025-07-30T14:16:11","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=24957"},"modified":"2025-10-15T12:58:26","modified_gmt":"2025-10-15T11:58:26","slug":"vitamin-b12-deficiency","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/vitamin-b12-deficiency\/","title":{"rendered":"Vitamin B12 Deficiency"},"content":{"rendered":"\n<p>Covid-19 prompted the British Society of Haematology to issue <a href=\"https:\/\/b-s-h.org.uk\/media\/18275\/bsh-guidance-b12-replacement-covid-1901052020finalv.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">pandemic B12 guidance<\/a> and this outlines some of the principles for moving to oral B12 preparations.<\/p>\n\n\n<style>.kb-image24957_d8f51b-33 .kb-image-has-overlay:after{opacity:0.3;}<\/style>\n<div class=\"wp-block-kadence-image kb-image24957_d8f51b-33\"><figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1811\" height=\"2560\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-scaled.png\" alt=\"vitamin b12 chart\" class=\"kb-img wp-image-25098\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-scaled.png 1811w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-212x300.png 212w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-724x1024.png 724w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-768x1086.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-1086x1536.png 1086w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-1449x2048.png 1449w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/vitamin-b12-chart-1-806x1140.png 806w\" sizes=\"auto, (max-width: 1811px) 100vw, 1811px\" \/><\/figure><\/div>\n\n\n\n<h4 class=\"wp-block-heading\">Download PDF chart <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vitamin-B12-flowchart.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Vitamin-B12-flowchart.pdf<\/a><\/h4>\n\n\n\n<p><strong>C.M &amp; A.K. 01-08-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>This document outlines appropriate referrals to the haematology department.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p>Patients:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>with symptoms suggestive of either a spinal cord lesion (subacute combined degeneration or peripheral neuropathy) or visual (optic neuropathy) \u2013 same day emergency admission<\/li>\n\n\n\n<li>not responding haematologically to B12 replacement therapy (where folate and iron stores have been checked and are normal)<\/li>\n\n\n\n<li>with suspected malabsorption or disease of the terminal ileum should be referred to Gastroenterology<\/li>\n\n\n\n<li>with neurological symptoms should be discussed with Neurology if advice required.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><\/h4>\n\n\n\n<p>Uncomplicated B12 deficiency<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p><br>SCI Gateway Haematology at RIE, WGH or SJH.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong><u>Primary care investigations<\/u><\/strong><strong><u><\/u><\/strong><\/p>\n\n\n\n<p>See flow chart on the main welcome page for full detail. Initial tests include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC and film<\/li>\n\n\n\n<li>Serum ferritin<\/li>\n\n\n\n<li>Serum folate<\/li>\n\n\n\n<li>Reticulocyte count if anaemia or macrocytosis<\/li>\n\n\n\n<li>Intrinsic factor antibodies (lab will reflexly test if low B12 levels).<\/li>\n<\/ul>\n\n\n\n<p>Please also see macrocytosis \/ macrocytic anaemia \/ cytopenia guidelines, if relevant.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Thanks to the Vegan Society for allowing us to link to their website: <a href=\"https:\/\/www.vegansociety.com\/resources\/nutrition-and-health\/nutrients\/vitamin-b12\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.vegansociety.com\/resources\/nutrition-and-health\/nutrients\/vitamin-b12<\/a><\/p>\n\n\n\n<p>Devalia V et al (2014) Guidelines for the diagnosis and treatment of cobalamin and folate disorders <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/bjh.12959\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/bjh.12959<\/a> [Accessed 29.11.19]<\/p>\n\n\n\n<p>Linnebank et al (2011) Antiepileptic drugs interact with folate and vitamin B12 serum levels <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.22229\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.22229<\/a> [Accessed 22.10.19]<\/p>\n\n\n\n<p>Sukumar and Saravanan (2019) Investigating Vitamin B12 deficiency <a href=\"https:\/\/www.bmj.com\/content\/365\/bmj.l1865\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bmj.com\/content\/365\/bmj.l1865<\/a> [Accessed 29.11.19]<\/p>\n<\/div><\/div>\n<\/div>\n\n\n<style>.kb-image24957_571ff8-a6 .kb-image-has-overlay:after{opacity:0.3;}<\/style>\n<figure class=\"wp-block-kadence-image kb-image24957_571ff8-a6\"><img alt=\"\" class=\"kb-img\" \/><\/figure>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Covid-19 prompted the British Society of Haematology to issue pandemic B12 guidance and this outlines some of the principles for moving to oral B12 preparations. Download PDF chart Vitamin-B12-flowchart.pdf C.M &amp; A.K. 01-08-25<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3981,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1300],"class_list":["post-24957","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-vitamin-b12-deficiency"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/https-apps-nhslothian-scot-refhelp-vitamin-b12-deficiency\/\" rel=\"tag\">Vitamin B12 Deficiency<\/a>","rttpg_excerpt":"Covid-19 prompted the British Society of Haematology to issue pandemic B12 guidance and this outlines some of the principles for moving to oral B12 preparations. Download PDF chart Vitamin-B12-flowchart.pdf C.M &amp; A.K. 01-08-25","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24957","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=24957"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24957\/revisions"}],"predecessor-version":[{"id":25564,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24957\/revisions\/25564"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3981"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=24957"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=24957"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}