Healthcare Professionals Information

Information to help you and your patients
We have identified that there are serious problems with the way in which vitamin B12 deficiency in general, and Pernicious Anaemia in particular is diagnosed and treated.
This is why we have created this page to keep you informed and up to date with facts and research surrounding this information.

Managing Pernicious Anaemia in the time of Corononavirus

What can GP surgeries do when there simply is not the time or staff to deal with routine injections? At this time of crisis, we are all having to be creative, and take a little more calculated risk than we normally feel comfortable with. We are assessing more people by phone, get pictures sent by email, while safetynetting extra carefully.
For managing pernicious anaemia at this time, there are several options.

By Willemina Rietsema, GP in Oxfordshire

Key Recommendations B12 Deficiency

  • The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status since there is no ‘gold standard’ test to define deficiency.
  • Definitive cut-off points to define clinical and subclinical deficiency states are not possible, given the variety of methodologies used and technical issues.
  • Neurological symptoms due to cobalamin deficiency may occur in the presence of a normal MCV/Hb.
  • Plasma tHcy and/or plasma MMA, depending on availability, may be considered as supplementary tests to determine biochemical cobalamin deficiency in the presence of clinical suspicion of deficiency but an indeterminate serum cobalamin level.
  • Serum cobalamin level of greater than 148 pmol/L (200 ng/l) in the presence of a strong clinical suspicion of cobalamin deficiency should be evaluated further with MMA, tHcy or HoloTC and a trial of hydroxocobalamin given to ascertain any clinical improvement.

Key Recommendations Pernicious Anaemia

  • All patients with anaemia, neuropathy or glossitis, and suspected of having pernicious anaemia, should be tested for anti-intrinsic factor antibody regardless of cobalamin levels.
  • Patients found to have a low serum cobalamin level in the absence of anaemia, and who do not have food malabsorption or other causes of deficiency, should be tested for IFAB to clarify whether they have an early/latent presentation of pernicious anaemia.
  • Patients found to be positive for intrinsic factor antibodies should have lifelong therapy with cobalamin.
  • Patients negative for intrinsic factor antibody, with no other causes of deficiency, may still have pernicious anaemia as a result of poor sensitivity of the test and should be treated as anti-intrinsic factor antibody negative pernicious anaemia. Lifelong therapy should be continued in the presence of an objective clinical response.

Key Recommendations Treatment:

  • Treatment of cobalamin deficiency is recommended in line with the British National Formulary:
    By intramuscular injection:
    Without neurological involvement: Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2–3 months.
    With neurological involvement: Initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months.
  • Measuring cobalamin levels is unhelpful as levels increase with treatment regardless of how effective it is. (NICE Clinical Knowledge Summaries)

Become a Healthcare Affiliate Member of the Pernicious Anaemia Society

Apply for a Healthcare Affiliate Membership, giving you full access to our Library and get our newsletter and event invites by email.

When to test (serum) B12?

  • Macrocytic anaemia
  • Neurological/neuropsychiatric symptoms: paresthesia, aphasia, ataxia, sensory loss, dementia, psychosis, paranoia, depression, mood swings, behavioural changes, etc
  • Symptoms as glossitis, extreme fatigue, loss of appetite, see more
  • Diabetes, Auto-immune thyroid disease, Crohn’s disease, MS, pancreatic insufficieny, gastric bypass, coeliac disease
  • Use of medication : metformin, ppi’s, Questran, colchicine
  • Vegan/strict vegetarian diet

Read More

Guidelines on Cobalamin and Folate issued by the British Committee for Standards in Haematology
Full Guideline
Videos/documentaries about PA/B12 deficiency including from our Conferences on Pernicious Anaemia

Take a moment to look at our Diagnosis & Treatment pages

If you would like us to come and give a talk at an event please contact us.

Healthcare Affiliate Member

Application to become a Healthcare Affiliate Member of the Pernicious Anaemia Society

We are pleased to offer those who work in Healthcare free membership of the society but, as you can imagine, we need to ensure that the system is not being abused. I am sure you will understand. Please fill out the form and add any additional information in the Comments Box.

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