Pernicious anaemia treatment during COVID-19

Non-dietary vitamin B12 deficiency

(e.g. pernicious anaemia, prior gastrectomy, bariatric surgery, achlorhydria, pancreatic insufficiency, short bowel syndrome, bacterial overgrowth, inflammatory bowel disease)
NICE Clinical Knowledge Summary 2019: administer hydroxocobalamin 1 mg intramuscularly every 2–3 months for life

British Society for Haematology advice during the COVID-19 pandemic for patients
established on intramuscular hydroxocobalamin:

The need for intramuscular (IM) hydroxocobalamin should be discussed with each patient individually. We recommend that screening questions for COVID-19 infection are asked before patients attend their GP surgeries. Alternatives to attending the GP surgery such as local pharmacies or home administration by district nurses should be explored.

As an alternative, oral cyanocobalamin can be offered at a dose of 1 mg per day until regular IM hydroxocobalamin can be resumed, i.e. once GP surgeries are able to do so safely, aiming to have a shortest possible break from regular injections.

Patients should be advised to monitor their symptoms and should contact their GP if they begin to experience neurological or neuropsychiatric symptoms such as pins and needles, numbness, problem with memory or concentration or irritability.

Patients who are already self-administering IM hydroxocobalamin should continue to do so but we do not recommend a patient switching to self-administration during the COVID-19 pandemic since instruction is likely to be difficult

https://b-s-h.org.uk/media/18275/bsh-guidance-b12-replacement-covid-1901052020finalv.pdf