Why Vitamin B12 Deficiency Should be on your Radar Screen

<strong>Vitamin</strong> <strong>B12</strong> <strong>Deficiency</strong>
Summary
Low vitamin <strong>B12</strong> levels occur among 1 in 31 adults 51
years of age or older among the U.S. population. <strong>Vitamin</strong>
<strong>B12</strong> deficiency is simple to prevent and simple to treat,
but the diagnosis is easy to miss and is often overlooked
in the outpatient setting.
All patients with unexplained hematologic or neurologic
symptoms should <strong>be</strong> evaluated for a vitamin <strong>B12</strong>
deficiency. If such a deficiency is found, the cause
should <strong>be</strong> determined.(7, 44) Irreversible neurologic
damage can occur if diagnosis and treatment are
delayed.
A complete blood count, peripheral blood smear, and
serum vitamin <strong>B12</strong> level are the tests of choice for initial
assessment of cobalamin deficiency. Keep in mind that
megaloblastic anemia and changes in mean corpuscular
value are not always present when there is a vitamin <strong>B12</strong>
deficiency. Homcysteine and methylmalonic acid can <strong>be</strong>
used to confirm a vitamin <strong>B12</strong> deficiency for cases with
ambiguous initial results <strong>be</strong>cause metabolic changes
often precede low cobalamin levels.
You have inexpensive treatment options available to
treat a vitamin <strong>B12</strong> deficiency. Remem<strong>be</strong>r that treatment
is safe, effective, and has no known toxicity level.
To prevent a vitamin <strong>B12</strong> deficiency, you should advise
all patients 51 years of age or older to consume
synthetic vitamin <strong>B12</strong> daily. Dosage recommendations
vary.
Acknowledgements: The authors thank Christine Pfeiffer, PhD, for
assistance with laboratory interpretation, and Quanhe Yang,
PhD,and Heather Carter Hamner, MS, MPH, for statistical support.
We also appreciate the comments and suggestions from our panel
of reviewers Sonja Rasmussen, MD; Joe Mulinare, MD; R.J. Berry,
MD; Lorraine Yeung, MD; Sharon Roy, MD; Mary Dott, MD; John
Mersereau, MD; Jennifer Zreloff, MD; Jason Bell, MD; Pauline
Terebuh, MD; Dan Watkins, PA; Gail Walls, MSN; Sally Lehr, MSN;
Darla Ura, MSN; Sue Ann Bell, MSN; Christa Purnell, MSN; Molly
Cogswell, RN, PhD, and Malissa Perritt, MSN.
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