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.

Treating Pernicious Anaemia and the current COVID-19 pandemic - A Guide for Doctors

The Pernicious Anaemia Society is fully supportive of any measures taken to reduce the risk of health care professionals contracting the Covid-19 virus. The Guideline balances the need for patients to receive their parenteral replacement therapy injections whilst reducing the risk to front-line staff of cross-infection.

Managing Pernicious Anaemia in the time of Corononavirus

The stresses on GPs and surgeries are immense during this coronavirus crisis. Some of the workforce are self-isolating, the rest are hard-pressed to keep the service going. Moreover, we are trying to reduce the number of face-to-face contacts to the absolute minimum. This includes some of the regular appointments for routine care.
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


NICE Management of anaemia - vitamin B12 and folate deficiency


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 consultants, doctors and researchers free membership of the society. Please fill out the form and add any additional information in the Comments Box.

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