STATEMENT ON THE CURRENT COVID-19 PANDEMIC AND PATIENTS’ TREATMENT BEING STOPPED
One of the measures that has been introduced in many, though not all surgeries and health centres, has been to cancel the replacement therapy injections of Vitamin B12 used to treat patients with Pernicious Anaemia in order to minimise the risk of cross infection. This has led to this society being inundated with telephone calls, emails and social media posts from patients who have been told they will no longer receive their life-saving injection. This group of patients are frightened, some extremely frightened, that they will develop irreversible nerve damage, and may even die, if they do not receive their treatment. Whilst this society acknowledges that cancelling appointments will help to minimise the risk of contamination, we are disappointed that patients are not being told of other given alternative treatments which will hopefully prevent any nerve damage and might help alleviate the symptoms of B12 Deficiency.
And, of course, patients who don’t receive treatment will have their B12 levels depleted which seriously compromises their immune system, leaving them more vulnerable to Covid-19.
Consequently, we consider the Treatment of Pernicious Anaemia to be essential.
The most sensible approach to patients getting their treatment is that outlined by Public Health Wales who have stated that on the day of the appointment, the patient is telephoned by their GP or nurse and asked a series of questions relating to the symptoms of Covid-19. If the patient has any symptoms then he or she has the appointment cancelled. If there are no symptoms then the appointment goes ahead.
If the appointment is cancelled then other delivery methods should be discussed. These include:
- Self-Treating. This is advised ‘where appropriate’ by the RCGP & BMA.
A great many members of the Pernicious Anaemia Society already self-inject after receiving training from a health professional using Hydroxocobalamin and sterile equipment prescribed by their GP.
- Prescribing B12 injections to the patient who then finds a health professional – usually a family member or friend – who will inject him or her at home.
- Those that would not be able to self-inject, should be provided with an alternative delivery method.
- Sub-Lingual Lozenges
- Sub-Lingual Sprays
- Sub-Lingual Drops
- Transdermal Patches
- Nasal Sprays
- 1mg or 2mg oral tablets
Although there has been no thorough evaluation of these alternative treatments, some patients have reported positive results though others do not. Some patients respond better to one alternative treatment than others. These are widely available from internet stores such as Amazon. We recommend monitoring symptoms when using one of the alternatives. Two apps that can help with monitoring are Flaredown and Health Mapper.
Popular alternative delivery methods include:
Note, it is highly unlikely that the often prescribed 50mcg tablets will be of any use to patients with Autoimmune Pernicious Anaemia. These 50mcg tablets are licensed for vitamin B12 deficiency of dietary origin only. For patients with Pernicious Anaemia 1,000 microgrammes or 1 milligram should be provided. These tablets may work for some patients, but not all will derive any benefit, though why this is so is not yet understood..