Pernicious anaemia treatment during COVID-19

Articles & Resources

Guidelines on Pernicious Anaemia during COVID-19

NICE

How should my management of vitamin B12 deficiency vary when considering the possibility of COVID-19?

Non-dietary vitamin B12 deficiency

Discuss the need for intramuscular (IM) hydroxocobalamin with each person.
Ask people who require IM hydroxocobalamin COVID-19 screening questions before they attend GP surgeries.

Explore alternatives to attending GP surgeries for administration, such as local pharmacies or home administration by district nurses.

Offer oral cyancobalamin 1 mg per day as an alternative until regular IM hydroxocobalamin can be resumed — aim for the shortest possible break from regular injections.

Advise people to monitor their symptoms and contact their GP if they begin to experience neurological or neuropsychiatric symptoms, such as pins and needles, numbness, problems with memory or concentration, or irritability.

People who are already self-administering IM hydroxocobalamin should continue to do so.
Switching to self-administration during the COVID-19 pandemic is not recommended as instruction is likely to be difficult.

https://cks.nice.org.uk/anaemia-b12-and-folate-deficiency#!scenarioRecommendation:4
https://cks.nice.org.uk/coronavirus-covid-19#!scenario:1

BSH

BSH guidance on B12 supplements during COVID pandemic

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

Articles about Pernicious Anaemia during COVID-19

News articles about Pernicious Anaemia during COVID-19

BSH guidance on B12 during Covid-19 changed

BSH guidance on B12 during Covid-19 changed

The last two weeks have been a very testing time for the society. This is because various professional bodies have issued Guidelines to doctors and other health professionals on how to deal with the unfolding Covid-19 pandemic. The British Society for Haematology...

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Recent developments regarding injections being stopped

Recent developments regarding injections being stopped

The problem of patients being told that they will not be receiving their injections due to the risk of spreading the Covid-19 virus has been the sole topic in telephone calls and emails to the society in the past two weeks. We are working hard to help our members in...

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General information about Pernicious Anaemia

PAS check

Testing B12 during treatment

Serum B12 levels cannot be used to determine the maintenance treatment frequency
PAS check

NICE Management of anaemia - vitamin B12 and folate deficiency

For people with neurological involvement: Initially administer hydroxocobalamin 1 mg intramuscularly on alternate days until there is no further improvement, then administer hydroxocobalamin 1 mg intramuscularly every 2 months.
For people with no neurological involvement: Initially administer hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks. Maintenance dose: hydroxocobalamin 1 mg intramuscularly every 2–3 months for life.

https://cks.nice.org.uk/anaemia-b12-and-folate-deficiency#!scenario

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