Materiały źródłowe

• #1

  https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/causes/

  Vitamin B12 or folate deficiency anaemia occurs when a lack of either of these vitamins affects the body’s ability to produce fully functioning red blood cells. […] A vitamin B12 or folate deficiency can be the result of a variety of problems. […] Pernicious anaemia is the most common cause of vitamin B12 deficiency in the UK. […] Some people can develop a vitamin B12 deficiency as a result of not getting enough vitamin B12 from their diet. […] Some stomach conditions or stomach operations can prevent the absorption of enough vitamin B12. […] Some conditions that affect your intestines can also stop you absorbing the necessary amount of vitamin B12. […] Some types of medicine can lead to a reduction in the amount of vitamin B12 in your body. […] Some people can experience problems related to a vitamin B12 deficiency, despite appearing to have normal levels of vitamin B12 in their blood.

• #1 Vitamin B12 Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441923/

  Vitamin B12 deficiency has 4 primary etiologies: […] Autoimmune: Pernicious anemia is an autoimmune condition in which antibodies to intrinsic factors are produced. Anti-intrinsic factor antibodies bind to and inhibit the effects of intrinsic factors, resulting in an inability of B12 to be absorbed by the terminal ileum. […] Malabsorption: Parietal cells in the stomach produce intrinsic factors; therefore, any patient with a history of gastric bypass surgery may be at risk for developing a B12 deficiency because their new alimentary pathway bypasses the site of intrinsic factor production. In patients with normal intrinsic factor production, any damage to the terminal ileum, such as surgical resection due to Crohn’s disease, will impair the absorption of B12 and lead to a deficiency. Other damage to the small intestine, such as inflammation from celiac disease or infection with the tapeworm Diphyllobothrium latum, may also result in a B12 deficiency.

• #1 Vitamin B12 Deficiency: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0915/p384.html

  Vitamin B12 deficiency is a common cause of megaloblastic anemia, various neuropsychiatric symptoms, and other clinical manifestations. […] Certain risk factors increase the prevalence of vitamin B12 deficiency. Dietary insufficiency, pernicious anemia (i.e., an autoimmune process that reduces available intrinsic factor and subsequent absorption of vitamin B12), and long-term use of metformin or acid-suppressing medications have been implicated in B12 deficiency. […] Pernicious anemia refers to one of the hematologic manifestations of chronic auto-immune gastritis, in which the immune system targets the parietal cells of the stomach or intrinsic factor itself, leading to decreased absorption of vitamin B12. […] Patients diagnosed with vitamin B12 deficiency whose history and physical examination do not suggest an obvious dietary or malabsorptive etiology should be tested for pernicious anemia with anti-intrinsic factor antibodies, particularly if other autoimmune disorders are present.

• #1 Pernicious anemia – Wikipedia

  https://en.wikipedia.org/wiki/Pernicious_anemia

  Pernicious anemia refers to a type of vitamin B12 deficiency anemia that results from lack of intrinsic factor. […] Lack of intrinsic factor is most commonly due to an autoimmune attack on the cells that create it in the stomach. […] Other disorders that can disrupt the absorption of vitamin B12 in the small intestine include celiac disease, surgical removal, Crohn’s disease, and HIV. […] PA may be considered as an end stage of autoimmune atrophic gastritis, a disease characterised by stomach atrophy and the presence of antibodies to parietal cells and intrinsic factor. […] Antibodies to intrinsic factor and parietal cells cause the destruction of the oxyntic gastric mucosa, in which the parietal cells are located, leading to the subsequent loss of intrinsic factor synthesis. […] Without intrinsic factor, the ileum can no longer absorb the B12.

• #1 Pernicious Anemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/204930-overview

  Pernicious anemia is the most common cause of severe vitamin B12 deficiency worldwide and is due to autoimmune destruction of parietal cells and/or intrinsic factor. […] Cobalamin deficiency may result from dietary insufficiency of vitamin B12; disorders of the stomach, small bowel, and pancreas; certain infections; and abnormalities of transport, metabolism, and utilization. […] Classic pernicious anemia produces cobalamin deficiency due to failure of the stomach to secrete intrinsic factor. […] In adults, pernicious anemia is associated with severe gastric atrophy and achlorhydria, which are irreversible. […] Cobalamin deficiency may result from inadequate dietary intake, atrophy or loss of gastric mucosa, functionally abnormal intrinsic factor, inadequate proteolysis of dietary cobalamin, insufficient pancreatic protease, bacterial overgrowth in the intestine, and disorders of ileal mucosa.

• #1 Pernicious anemia – Wikipedia

  https://en.wikipedia.org/wiki/Pernicious_anemia

  Although the exact role of Helicobacter pylori infection in PA remains controversial, evidence indicates H. pylori is involved in the pathogenesis of the disease. […] Impaired B12 absorption can also occur following gastric removal (gastrectomy) or gastric bypass surgery. […] Although no specific PA susceptibility genes have been identified, a genetic factor likely is involved in the disease.

• #1

  https://111.wales.nhs.uk/encyclopaedia/a/article/anaemia,vitaminb12andfolatedeficiency

  Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cannot function properly. […] There are a number of problems that can lead to a vitamin B12 or folate deficiency. […] These include pernicious anaemia where your immune system attacks healthy cells in your stomach, preventing your body absorbing vitamin B12 from the food you eat; this is the most common cause of vitamin B12 deficiency in the UK. […] A diet that includes meat, fish and dairy products usually provides enough vitamin B12, but people who do not regularly eat these foods can become deficient. […] Some stomach conditions or stomach operations can prevent the absorption of enough vitamin B12. […] Some conditions that affect your intestines can also stop you absorbing the necessary amount of vitamin B12.

• #1 Vitamin B12 Deficiency Anemia: Symptoms, Causes, Treatments

  https://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia

  Health conditions like HIV, diabetes, and alcohol use disorder (alcoholism) put you at risk for vitamin B12 deficiency. […] Older adults are more likely to have vitamin B12 deficiency because they’re prone to not having enough hydrochloric acid in their stomachs. […] You’ve had bypass surgery for weight loss, which removes part of your stomach. […] If you let it go for too long, it can cause problems in your nervous system such as vision problems, memory loss, and difficulty speaking or walking due to ataxia. […] If you’re pregnant and don’t get enough vitamin B12, your baby is at risk of a serious birth defect called a neural tube defect.

• #1 Megaloblastic Anemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/204066-overview

  Megaloblasts are large nucleated red blood cells. Vitamin B12 deficiency (eg, pernicious anemia), folic acid deficiency, and certain medications are the most common causes of megaloblastic anemia, a macrocytic anemia. […] The most common causes of megaloblastosis are vitamin B12 and folate deficiencies, medications, and direct interference of DNA synthesis by HIV infections and myelodysplastic disorders. […] Cobalamin deficiency may result from the following: Atrophy or loss of gastric mucosa (eg, pernicious anemia, gastrectomy, ingestion of caustic material, hypochlorhydria, histamine 2 [H2] blockers), Functionally abnormal intrinsic factor (IF), Inadequate dietary intake (ie, vegetarian diet), Inadequate proteolysis of dietary cobalamin, Insufficient pancreatic protease (eg, chronic pancreatitis, Zollinger-Ellison syndrome [ZES]), Bacterial overgrowth in intestine (eg, blind loop, diverticula) – Bacteria compete with the body for cobalamin, Diphyllobothrium latum (fish tapeworm) – Competes with the body for cobalamin, Disorders of ileal mucosa (eg, resection, ileitis, sprue, lymphoma, amyloidosis, absent IF-cobalamin receptor, Imerslund-Grasbeck syndrome, ZES, transcobalamin II [TCII] deficiency, use of certain drugs), Disorders of plasma transport of cobalamin (eg, TCII deficiency, R-binder deficiency), Dysfunctional uptake and use of cobalamin by cells (eg, defects in cellular deoxyadenosylcobalamin [AdoCbl] and methylcobalamin [MeCbl] synthesis).

• #1 Anaemia, vitamin B12 and folate deficiency | Nursing Times

  https://www.nursingtimes.net/archive/anaemia-vitamin-b12-and-folate-deficiency-06-02-2009/

  If your anaemia is being caused by a vitamin B12 deficiency, you may also notice other symptoms, including: […] A folate deficiency may also cause: […] Folate deficiency anaemia can also develop for a number of reasons, some of which are outlined below. […] Some people do not have enough folate in their daily diet. […] Sometimes, your body may be unable to absorb folate as effectively as it should. […] You may lose folate if you have to urinate very frequently because of an underlying condition that affects your kidney or liver, or other organs. […] Sometimes, your body requires more folate than normal. […] If you are pregnant, you should take a daily supplement of 0.4mg of folic acid for the first 12 weeks of your pregnancy. […] If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you will be prescribed vitamin B12 tablets.

• #1

  https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/

  Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cannot function properly. […] There are a number of problems that can lead to a vitamin B12 or folate deficiency. […] These include: pernicious anaemia where your immune system attacks healthy cells in your stomach, preventing your body absorbing vitamin B12 from the food you eat; this is the most common cause of vitamin B12 deficiency in the UK. […] A lack of these vitamins in your diet this is uncommon, but can happen if you have a vegan diet and do not take vitamin B12 supplements or eat foods fortified with vitamin B12, follow a restrictive diet or have a generally poor diet for a long time. […] Certain medicines, including anticonvulsants and proton pump inhibitors (PPIs), can affect how much of these vitamins your body absorbs.

• #1 Vitamin B12 Deficiency Anemia: Symptoms, Causes, Treatments

  https://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia

  This type of anemia means that your body doesn’t have enough healthy red blood cells because you’re low in vitamin B12. […] You can have vitamin B12 deficiency anemia if you don’t get enough vitamin B12 in your diet from foods like milk, eggs, and meat, or if your body can’t absorb B12 because of a health problem. […] This is the most common cause of vitamin B12 deficiency worldwide and mainly affects people of Northern European ancestry. […] Vitamin B12 is only found in animal products like meat, eggs, and milk. So if you’re on a vegan or vegetarian diet where you’re not eating foods from animals, you’re at risk for B12 deficiency. […] If you have a stomach or small intestine condition such as celiac disease or Crohn’s disease, you may not be able to absorb enough vitamin B12 from food.

• #1 Vitamin B12 Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441923/

  Dietary insufficiency: Vitamin B12 is stored in excess in the liver; however, patients who have followed a strict vegan diet for approximately 3 years may develop a B12 deficiency from a lack of dietary intake. […] Toxin exposure: Exposure to nitrous oxide can cause vitamin B12 deficiency and neurologic symptoms. Metformin treatment can cause B12 deficiency.

• #1 Anemia – Vitamin B12–Deficiency Anemia | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/anemia/vitamin-b12-deficiency-anemia

  Vitamin B12deficiency anemia, also known as cobalamin deficiency, is a condition that develops when your body can’t make enough healthy red blood cells because it doesn’t have enough vitamin B12. […] You can develop vitamin B12 deficiency for the following reasons: […] Lack of intrinsic factor: Intrinsic factor is a protein made in the stomach, which helps the body absorb vitamin B12. People who have pernicious anemia do not produce intrinsic factor. […] You can develop vitamin B12deficiency anemia if you do not eat enough food with vitamin B12, such as if you follow a strict vegetarian or vegan diet. But this is rare. In the United States, vitamin B12deficiency anemia is most often due to other risk factors. […] Some medical conditions can raise your risk of vitamin B12deficiency anemia. These include: Autoimmune diseases, such as celiac disease, type 1 diabetes, and thyroid disease. […] Surgery on your stomach or intestines, such as weight-loss surgery or gastrectomy, can make it harder for your body to absorb vitamin B12.

• #1 Vitamin B12 deficiency – Wikipedia

  https://en.wikipedia.org/wiki/Vitamin_B12_deficiency

  Vitamin B12 deficiency can lead to anemia, neurologic, and digestive dysfunctions. […] A late finding type of anemia known as megaloblastic anemia is often but not always present. […] Causes are usually related to conditions that give rise to malabsorption of vitamin B12 particularly autoimmune gastritis in pernicious anemia. […] Other conditions giving rise to malabsorption include surgical removal of the stomach, chronic inflammation of the pancreas, intestinal parasites, certain medications such as long-term use of proton pump inhibitors, H2-receptor blockers, and metformin, and some genetic disorders. […] Deficiency can also be caused by inadequate dietary intake such as with the diets of vegetarians, and vegans, and in the malnourished. […] Deficiency may be caused by increased needs of the body for example in those with HIV/AIDS, and shortened red blood cell lifespan.

• #1

  https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/causes/

  Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. […] Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol, and people following a restrictive diet that does not involve eating good sources of folate. […] Sometimes your body may be unable to absorb folate as effectively as it should. […] You may lose folate from your body if you pee frequently. […] Some types of medicines reduce the amount of folate in your body or make the folate harder to absorb. […] Your body sometimes requires more folate than normal. This can cause folate deficiency if you cannot meet your body’s demands for the vitamin.

• #1 Anaemia, vitamin B12 or folate deficiency – Causes of vitamin B12 or folate

  https://www.ibdrelief.com/learn/complications-of-ibd/vitamin-and-mineral-deficiencies-in-ibd/vitamin-b12-and-ibd/anaemia-vitamin-b12-or-folate-deficiency-causes-of-vitamin-b12-or-folate-deficiency-anaemia

  Some types of medicine can lead to a reduction in the amount of vitamin B12 in your body. […] Some people can experience problems related to a vitamin B12 deficiency, despite appearing to have normal levels of vitamin B12 in their blood. […] Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. […] Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol and people following a fad diet that doesn’t involve eating good sources of folate. […] Sometimes your body may be unable to absorb folate as effectively as it should. […] Some types of medicine reduce the amount of folate in your body, or make the folate harder to absorb. […] Your body sometimes requires more folate than normal. […] If you are pregnant or trying to get pregnant, it is recommended that you take a 400 microgram folic acid tablet every day until you are 12 weeks pregnant.

• #1 Folate Deficiency: Recognize Symptoms & Causes | Ada

  https://ada.com/conditions/folate-deficiency/

  Alcohol-related damage to the liver, which affects the way in which folate is stored in the liver and increases the amount of folate excreted in urine. People with alcohol dependence may also have a nutritionally insufficient diet. […] Pregnancy and lactation, which raise the bodys demand for folate considerably due to the growth of new tissue in both mother and fetus. Sufficient folic acid supplementation is crucial for pregnant women, as a deficiency may cause birth defects. […] Anemia and folate deficiency. Megaloblasts are large, poorly-formed red blood cells that form in cases of anemia caused by, among others, folate or B12 deficiencies. Megaloblastic anemia is a result of folate deficiency as well as one of the most easily-identified symptoms: sometimes, a deficiency is only identified when anemia presents. If it results from folate deficiency, this anemia, is treated by taking oral or intravenous folate supplements.

• #1 Folate Deficiency: Recognize Symptoms & Causes | Ada

  https://ada.com/conditions/folate-deficiency/

  Folate deficiency has a number of potential causes. Most healthy people absorb sufficient folate from their diets to avoid deficiency, but in some cases the body may increase demand, which, if supplementation doesnt occur, may lead to deficiency. In other cases, the body may be unable to absorb enough folate, due to low intake or excessive excretion. […] Causes of folate deficiency include: Low dietary intake due to medically restricted diets such as those followed by people with phenylketonuria or due to fad diets concentrating on foods that do not contain enough folate. Infants who are fed unfortified goats milk will also experience folate deficiency, as folate is not naturally present in goats milk. […] Disorders such as leukaemia, carcinomas and lymphomas, which increase the bodys demand for folate and may consequently lead to deficiency if folic acid supplements arent taken.

• #1 Anaemia, vitamin B12 and folate deficiency | Nursing Times

  https://www.nursingtimes.net/archive/anaemia-vitamin-b12-and-folate-deficiency-06-02-2009/

  Anaemia is a condition that occurs when there is a reduced number of red blood cells or concentration of haemoglobin. […] Other forms of anaemia can be caused by a lack of vitamin B12 or folate in your body. […] A vitamin B12 deficiency is rare in younger people, and is most common in people who are over 75 years of age. Folate deficiency is also most common in people over 75 years of age. People following a strict vegan diet tend to be more at risk of developing a vitamin B12 deficiency. […] The body usually stores enough vitamin B12 to last for approximately two to four years. However, it is important that you have vitamin B12 in your diet in order to ensure that this store of the vitamin is kept at a healthy level. […] In the UK, pernicious anaemia is the most common cause of vitamin B12 deficiency. Pernicious anaemia is an autoimmune disease that affects your stomach.

• #1 Megaloblastic Anemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/204066-overview

  Major causes for folate deficiency include: Folate content in foods and the preparation of foods are major causes for folate deficiency, especially in elderly persons. Folates are very thermolabile. Therefore, excessive heating can lead to inactivation, especially when foods are excessively diluted in water. […] Intestinal disorders that impede folate absorption include tropical sprue, nontropical sprue (celiac disease or gluten sensitivity), amyloidosis, and inflammatory bowel disease.

• #1 Folate-deficiency anemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000551.htm

  Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate. Folate is a type of B vitamin. It is also called folic acid. […] Causes of this type of anemia include: Too little folic acid in your diet, Hemolytic anemia, Long-term alcoholism, Use of certain medicines (such as phenytoin [Dilantin], methotrexate, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, and barbiturates). […] The following raise your risk for this type of anemia: Alcoholism, Eating overcooked food, Poor diet (often seen in the poor, the older people, and people who do not eat fresh fruits or vegetables), Pregnancy, Weight loss diets. […] Folic acid is needed to help a baby in the womb grow properly. Too little folic acid during pregnancy may lead to birth defects in a baby.

• #1 Folic Acid Deficiency: Causes, Symptoms, and Treatment

  https://patient.info/allergies-blood-immune/anaemia-leaflet/folic-acid-deficiency-anaemia

  Some blood disorders can lead to a very high turnover of red blood cells – for example, sickle cell disease and thalassaemia. Normal amounts of folic acid in the diet may then not be enough and supplements may need to be taken. […] Complications of folic acid deficiency are rare but can occur, especially if you have been deficient in folic acid for some time. When folic acid causes anaemia this can lead to heart problems, especially in the elderly. […] A blood test can confirm folic acid deficiency and whether you are anaemic. It is also very common to have a blood test for your vitamin B12 levels at the same time, as these can also be low.

• #1 Evaluation of Macrocytosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0201/p203.html

  The normal range for serum measures of vitamin B12 varies among laboratories. If the vitamin B12 level is borderline low (i.e., 100 to 400 pg per mL [74 to 295 pmol per L]), methylmalonic acid and homocysteine levels should be ordered and, if elevated, may provide evidence of B12 deficiency. […] The history of folate deficiency may mimic the history of vitamin B12 deficiency in regard to poor nutritional intake or absorption. […] Some medications that are used to treat seizure disorders, cancer, and autoimmune diseases can lead to folate deficiency. […] RBC folate levels more accurately correlate with folate stores and should be performed if folate deficiency is suspected. […] In differentiating the cause of megaloblastic anemia, a methylmalonic acid level that is within normal range also points toward a diagnosis of folate deficiency, especially if the serum vitamin B12 level is within the normal range.

• #1

  https://111.wales.nhs.uk/encyclopaedia/a/article/anaemia,vitaminb12andfolatedeficiency

  Some types of medicine can lead to a reduction in the amount of vitamin B12 in your body. […] Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. […] Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol, and people following a restrictive diet that does not involve eating good sources of folate. […] Sometimes your body may be unable to absorb folate as effectively as it should. […] A lack of folate during pregnancy may increase the risk of the baby being born prematurely (before the 37th week of pregnancy) or having a low birth weight. […] A lack of vitamin B12 (with or without anaemia) can cause complications. […] A lack of folate (with or without anaemia) can also cause complications.

• #1 Vitamin Deficiency Anemia: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17732-vitamin-deficiency-anemia

  Vitamin deficiency anemia is a condition that develops when you have low levels of vitamin B12 or B9 (folate). In this type of anemia, your body doesn’t produce enough healthy red blood cells. […] Vitamin deficiency anemia is a condition in which your body doesn’t produce enough healthy red blood cells. It happens primarily when you have low levels of vitamin B12 or B9 (folate or folic acid). […] Both vitamins are crucial in many processes in your body, including making red blood cells. Without enough B12 or folic acid, your body doesn’t make normal red blood cells and those cells die more quickly than normal cells so they can’t carry oxygen to all of your body tissues. This lack of normal red blood cells is anemia. […] Vitamin deficiency anemia occurs when you have low vitamin B12 or folate levels. Causes of vitamin deficiency anemia may include: Certain medications, such as some anti-seizure drugs. Excessive alcohol use. Health conditions that affect nutrient absorption. History of gastric surgery. Intestinal problems such as tapeworms. Diet that doesn’t include adequate meats/fish, dairy products, eggs, or specific vegan options (B12) or dark green veggies, beans, nuts, seeds (folate). […] You are also at a higher risk of a folate deficiency if you are: Breastfeeding. Pregnant. On dialysis for kidney disease.

• #1 Vitamin B12 Deficiency: Signs, Causes and Treatments | Ada

  https://ada.com/conditions/vitamin-b12-deficiency/

  A deficiency of folate, the nutrient also known as folic acid or vitamin B9, can cause some of the same symptoms as vitamin B12 deficiency. […] Taking a lot of folic acid can mask the symptoms of a vitamin B12 deficiency, so in cases where folate deficiency is suspected, a doctor will usually test for vitamin B12 deficiency before prescribing medication.

• #1 Folate, iron and vitamin B6 | Pernicious Anaemia Society

  https://pernicious-anaemia-society.org/folic-acid-iron-and-vitamin-b6/

  There are two vitamins that are important in connection with vitamin B12: folate and vitamin B6. […] A deficiency of folate can cause anaemia, intestinal disorders, fatigue, depression and birth defects. […] Anaemia is often caused by an iron deficiency, but can also be caused by a deficiency of vitamin B12, B6 and/or folate. […] The effect of vitamin B12 is closely intertwined with that of folate, but these two vitamins are not interchangeable. […] When anaemia caused by a vitamin B12 deficiency (temporarily) disappears after the administration of folic acid, the premature conclusion is sometimes drawn that there was (only) a folic acid deficiency. […] Neurological symptoms resulting from a vitamin B12 deficiency can be exacerbated by the administration of folic acid, resulting in nerve damage that can become permanent. […] Vitamin B6, together with vitamin B12 and folate, is necessary for normalizing homocysteine levels. […] The symptoms of vitamin B6 deficiency include nervous system disorders, anaemia, loss of appetite, diarrhea, depression, skin problems, confusion, reduced resistance and glossitis.

• #1

  https://consensus.app/questions/difference-between-b12-and-iron-deficiency/

  Vitamin B12 deficiency is often due to inadequate dietary intake, malabsorption syndromes, or pernicious anemia, which is an autoimmune condition that affects the stomach’s ability to produce intrinsic factor necessary for B12 absorption. […] Other causes include chronic intestinal inflammation, as seen in inflammatory bowel diseases (IBD). […] Vitamin B12 and iron deficiencies can coexist, particularly in populations with malabsorption syndromes or dietary restrictions. […] Differentiating between B12 and iron deficiencies involves a combination of clinical evaluation and laboratory tests. Elevated homocysteine and methylmalonic acid levels are more indicative of B12 deficiency, while low ferritin and hepcidin levels point towards iron deficiency. […] The presence of neurological symptoms also strongly suggests B12 deficiency. […] Regular monitoring and substitution of vitamins and iron are crucial to prevent long-term intestinal and extraintestinal complications in inflammatory bowel disease patients.

• #1 Vitamin B12 Deficiency

  https://labtestsonline.org.uk/conditions/vitamin-b12-and-folate-deficiency

  B12 and folate deficiency may be due to insufficient intake, inadequate absorption, increased loss, or to increased need. […] B12 deficiency can be caused by insufficient stomach acid, which is necessary to separate B12 from dietary protein. […] Deficiency may also be due to a lack of intrinsic factor, a substance produced by special cells in the stomach called parietal cells. […] Both B12 and folate deficiencies can also arise with diseases or conditions of the gut that cause general malabsorption. […] Chronic disorders such as liver or kidney disease, and alcoholism can lead to decreased levels of B12 or folate, as can medications such as phenytoin, metformin (diabetic therapy), trimethoprim (an antibiotic sometimes given long-term) or methotrexate (an arthritis treatment). […] All pregnant women need increased amounts of folate for proper development of the baby.

• #1 Severe megaloblastic anemia: Vitamin deficiency and other causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/3/153

  Megaloblastic anemia causes macrocytic anemia from ineffective red blood cell production and intramedullary hemolysis. The most common causes are folate (vitamin B9) deficiency and cobalamin (vitamin B12) deficiency. […] Megaloblastic anemia is most commonly caused by folate deficiency from dietary deficiency, alcoholism, or malabsorption syndromes or by vitamin B12 deficiency, usually due to pernicious anemia. […] Both vitamin deficiencies cause hematologic signs and symptoms of anemia; vitamin B12 deficiency also causes neurologic symptoms. […] The most frequent causes of megaloblastic anemia are deficiencies of vitamin B9 (folate) or vitamin B12 (cobalamin). […] Causes of vitamin B12 deficiency are listed in Table 2. Dietary deficiency of vitamin B12 occurs less frequently than folate deficiency because body stores can last for years owing to efficient enterohepatic recycling mechanisms.

• #1 Anaemia, vitamin B12 and folate deficiency | Nursing Times

  https://www.nursingtimes.net/archive/anaemia-vitamin-b12-and-folate-deficiency-06-02-2009/

  To treat folate deficiency anaemia, your GP will normally prescribe folic acid tablets to help build up your folate levels. […] A lack of vitamin B12 can affect your nervous system. […] Research has shown that a lack of folate in your body may increase your risk of developing cardiovascular disease. […] Research has shown that folate deficiency can be linked to some cancers. […] A lack of vitamin B12 or folate can also cause other complications, some of which are outlined below.

• #1 Evaluation of Macrocytosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0201/p203.html

  Macrocytosis, generally defined as a mean corpuscular volume greater than 100 fL, is frequently encountered when a complete blood count is performed. The most common etiologies are alcoholism, vitamin B12 and folate deficiencies, and medications. […] When the peripheral smear indicates megaloblastic anemia (demonstrated by macroovalocytes and hypersegmented neutrophils), vitamin B12 or folate deficiency is the most likely cause. […] In recent years, an association has been found between Helicobacter pylori infection and vitamin B12 deficiency. […] Megaloblastic processes are characterized on the peripheral smear by macroovalocytes and hypersegmented neutrophils, which are absent in nonmegaloblastic macrocytic processes. […] In megaloblastic processes, erythrogenic precursors are larger than mature red blood cells (RBCs) because folate and vitamin B12 deficiencies result in defective RNA and DNA syntheses.

• #1 Severe megaloblastic anemia: Vitamin deficiency and other causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/3/153

  The most common hematologic manifestation is megaloblastic anemia, which includes macrocytic erythrocytes in the peripheral blood and megaloblastic precursor cells in the bone marrow that exhibit nuclear-to-cytoplasmic dyssynchrony. […] Symptoms secondary to anemia include fatigue, shortness of breath, and poor exercise tolerance. […] Vitamin B12 deficiency can cause subacute combined degeneration of the dorsal and lateral columns of the spinal cord.

• #1 Vitamin B12 & folate anaemia | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/nutritional/vitamin-b12-or-folate-deficiency-anaemia/

  A lack of folate during pregnancy may increase the risk of the baby being born prematurely (before the 37th week of pregnancy) or having a low birthweight. […] A lack of vitamin B12 (with or without anaemia) can cause neurological problems (issues affecting your nervous system), such as: vision problems, memory loss, pins and needles (paraesthesia), loss of physical coordination (ataxia), which can affect your whole body and cause difficulty speaking or walking, damage to parts of the nervous system (peripheral neuropathy), particularly in the legs.

• #1 Types of Anemia

  https://www.siemens-healthineers.com/laboratory-diagnostics/assays-by-diseases-conditions/anemia/types-of-anemia

  The most common causes of megaloblastic anemia are deficiency of either cobalamin (vitamin B12) or folate (vitamin B9). Your body needs folate and vitamin B12 to produce enough healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Additionally, some people may consume enough vitamin B12, but their bodies aren’t able to process the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious anemia. […] A deficiency in vitamin B12 can result in varying degrees of neuropathy or nerve damage. In severe cases, mental changes that range from confusion and irritability to dementia may occur. […] Pregnant women need increased folate for proper fetal development because of the added stress of rapidly growing fetal cells. A folate deficiency during pregnancy, especially in the early weeks when a woman might not know she is pregnant, may lead to premature birth and neural tube birth defects (NTDs) such as spina bifida in the child. […] Laboratory testing is used to detect a vitamin deficiency, determine its severity, establish it as the underlying cause of someone’s symptoms, and to monitor the effectiveness of treatment.

• #1 Folate Deficiency: Recognize Symptoms & Causes | Ada

  https://ada.com/conditions/folate-deficiency/

  Folic acid is very important in the correct development of cells and is crucial for the correct development of fetuses. Pregnant women and women planning to become pregnant should increase their folic acid intake to 400 micrograms a day. […] Folic acid deficiency in the mother can cause defects in the neural tube, which is the structure that eventually develops into the babys spinal cord. Neural tube defects (NTDs) can include spina bifida, caudal regressive (affecting the lowest part of the spine), and cleft palate. Extremely rare, but severe, complications of folic acid deficiency can include anencephaly and encephaloceles, which involve the babys skull and brain.

• #1 Vitamin B12 & folate anaemia | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/nutritional/vitamin-b12-or-folate-deficiency-anaemia/

  Vitamin B12 or folate deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cant function properly. […] There are a number of problems that can lead to a vitamin B12 or folate deficiency, including: pernicious anaemia where your immune system attacks healthy cells in your stomach, preventing your body from absorbing vitamin B12 from the food you eat; this is the most common cause of vitamin B12 deficiency in the UK. […] A vitamin B12 or folate deficiency can be the result of a variety of problems, some of which are described below. […] Vitamin B12 or folate deficiency anaemia occurs when a lack of either of these vitamins affects the bodys ability to produce fully functioning red blood cells. […] A vitamin B12 deficiency can sometimes lead to temporary infertility (an inability to conceive).

• #1 Signs and Symptoms of Vitamin B12 Deficiency

  https://www.healthline.com/nutrition/vitamin-b12-deficiency-symptoms

  B12 deficiency can also cause a condition called jaundice, which makes your skin and the whites of your eyes take on a yellowish color due to high levels of bilirubin (2). […] B12 deficiency is associated with a greater risk of developing depression (14, 15). […] Having low levels of B12 can cause elevated levels of a sulfur-containing amino acid called homocysteine. In turn, this may contribute to the development of depression by increasing oxidative stress, DNA damage, and cell death in the body (16, 17). […] A 2020 study with 132 children and teens, 89 with and 43 without depression, found that the participants with depression had lower B12 levels and higher levels of homocysteine compared with those without depression (17). […] A B12 deficiency may also cause diarrhea, nausea, constipation, bloating, gas, and other gastrointestinal symptoms (2, 19).

• #1 Vitamin B-12 Deficiency Anemia

  https://johnshopkinshealthcare.staywellsolutionsonline.com/MentalHealth/85,P00080

  Risk factors for vitamin B-12 deficiency anemia include: […] A family history of the disease […] Surgery that removes part or all of your stomach or intestine […] Autoimmune diseases, including type 1 diabetes […] Crohn’s disease […] HIV […] Some medicines […] Strict vegetarian or vegan diets […] Older age […] Symptoms include weak muscles, numbness, trouble walking, nausea, weight loss, irritability, fatigue, and increased heart rate. […] Treatment may include vitamin B-12 supplements. It is also important to eat a well-balanced diet that is rich in Vitamin B-12.

• #1 3.7 Vitamin B12 and Folate Deficiency Anemia – Health Alterations

  https://wtcs.pressbooks.pub/healthalts/chapter/3-7-vitamin-b12-and-folate-deficiency-anemia/

  Decreased Absorption of Vitamin B12: Some people may consume adequate amounts of vitamin B12 but have issues with absorbing this vitamin. Risk factors for decreased absorption of vitamin B12 are a gastric bypass, Crohns disease or other inflammatory bowel disorder, chronic use of antacids or proton pump inhibitors (PPIs), chronic H. Pylori infection, gastric cancer, chronic use of metformin, and chronic excess alcohol intake. […] Autoimmune Disorder: Pernicious anemia is a specific type of vitamin B12 anemia. Pernicious anemia is an autoimmune disorder in which antibodies are formed that attack the stomach cells that produce intrinsic factor. […] Folate deficiency has become less common because food has been routinely supplemented with folic acid, but risk factors are similar to vitamin B12 deficiency. People who do not consume a varied, nutrient-rich diet are at risk for folate deficiency. For example, people with restrictive diets, anorexia nervosa, or those with excessive chronic alcohol use and a limited diet are at risk. Gastric bypass and inflammatory bowel disorders, as well as chronic medications such as methotrexate, antiseizure medications, and certain antibiotics, can also impact the absorption of folate.

• #1 Causes and pathophysiology of vitamin B12 and folate deficiencies – UpToDate

  https://www.uptodate.com/contents/causes-and-pathophysiology-of-vitamin-b12-and-folate-deficiencies

  Causes and pathophysiology of vitamin B12 and folate deficiencies […] Vitamin B12 deficiency can also cause neuropsychiatric findings. […] This topic review discusses the major causes of vitamin B12 and folate deficiency, along with their pathophysiology. […] CAUSES OF VITAMIN B12 DEFICIENCY […] Pernicious anemia […] Inadequate dietary intake […] Food cobalamin malabsorption […] Genetic disorders (vitamin B12) […] CAUSES OF FOLATE DEFICIENCY […] Inadequate dietary intake […] Increased requirements […] Intestinal malabsorption […] Medications (folate) […] Genetic disorders (folate).

• #1 Severe megaloblastic anemia: Vitamin deficiency and other causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/3/153

  Nearly every step of this pathway can be disrupted in various pathologic states, but lack of intrinsic factor secondary to pernicious anemia is the cause of vitamin B12 deficiency in most cases. […] Chronic atrophic autoimmune gastritis affects the body and fundus of the stomach, replacing normal oxyntic mucosa with atrophic-appearing mucosa, often with associated intestinal metaplasia. […] The laboratory and clinical findings were consistent with vitamin B12 deficiency, and the presence of anti-intrinsic factor antibody confirmed the diagnosis of pernicious anemia. […] Vitamin B12 deficiency causes hematologic and neuropsychiatric manifestations that may occur together or independently. […] Megaloblastic anemia due to folate deficiency and other causes shares the same hematologic manifestations as vitamin B12 deficiency but lacks the neurologic features.

• #1 Vitamin deficiency anemia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vitamin-deficiency-anemia/diagnosis-treatment/drc-20355031

  To help diagnose vitamin deficiency anemias, you might have blood tests that check for: […] The amount of vitamin B-12 and folate in the blood. […] Vitamin deficiency anemia is treated with doses of whichever vitamin is lacking. […] For pernicious anemia, vitamin B-12 is usually delivered via injection and may need to be taken regularly for the rest of your life. […] Medications to boost folate levels usually come as pills to be swallowed, but some versions can be delivered through a narrow, flexible tube into a vein (intravenously). […] Causes and pathophysiology of vitamin B12 and folate deficiency.

• #1 Vitamin B12 deficiency anemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000574.htm

  Vitamin B12 deficiency anemia is a low red blood cell count due to a lack (deficiency) of vitamin B12. […] Your body needs vitamin B12 to make red blood cells. In order to provide vitamin B12 to your cells: […] Certain health conditions can make it difficult for your body to absorb enough vitamin B12. They include: […] A lack of vitamin B12 may be due to dietary factors, including: […] Treatment depends on the cause of B12 deficiency anemia. The goal of treatment is to increase your vitamin B12 level. […] Long-term vitamin B12 deficiency can cause nerve damage. This may be permanent if you do not start treatment promptly after your symptoms begin. […] Vitamin B12 deficiency anemia most often responds well to treatment. It will likely get better when the underlying cause of the deficiency is treated.

• #2

  https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/

  Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cannot function properly. […] There are a number of problems that can lead to a vitamin B12 or folate deficiency. […] These include: pernicious anaemia where your immune system attacks healthy cells in your stomach, preventing your body absorbing vitamin B12 from the food you eat; this is the most common cause of vitamin B12 deficiency in the UK. […] A lack of these vitamins in your diet this is uncommon, but can happen if you have a vegan diet and do not take vitamin B12 supplements or eat foods fortified with vitamin B12, follow a restrictive diet or have a generally poor diet for a long time. […] Certain medicines, including anticonvulsants and proton pump inhibitors (PPIs), can affect how much of these vitamins your body absorbs.

• #2 Causes and pathophysiology of vitamin B12 and folate deficiencies – UpToDate

  https://www.uptodate.com/contents/causes-and-pathophysiology-of-vitamin-b12-and-folate-deficiencies

  Causes and pathophysiology of vitamin B12 and folate deficiencies […] Vitamin B12 deficiency can also cause neuropsychiatric findings. […] This topic review discusses the major causes of vitamin B12 and folate deficiency, along with their pathophysiology. […] CAUSES OF VITAMIN B12 DEFICIENCY […] Pernicious anemia […] Inadequate dietary intake […] Food cobalamin malabsorption […] Genetic disorders (vitamin B12) […] CAUSES OF FOLATE DEFICIENCY […] Inadequate dietary intake […] Increased requirements […] Intestinal malabsorption […] Medications (folate) […] Genetic disorders (folate).

• #2 Anaemia, vitamin B12 and folate deficiency | Nursing Times

  https://www.nursingtimes.net/archive/anaemia-vitamin-b12-and-folate-deficiency-06-02-2009/

  Anaemia is a condition that occurs when there is a reduced number of red blood cells or concentration of haemoglobin. […] Other forms of anaemia can be caused by a lack of vitamin B12 or folate in your body. […] A vitamin B12 deficiency is rare in younger people, and is most common in people who are over 75 years of age. Folate deficiency is also most common in people over 75 years of age. People following a strict vegan diet tend to be more at risk of developing a vitamin B12 deficiency. […] The body usually stores enough vitamin B12 to last for approximately two to four years. However, it is important that you have vitamin B12 in your diet in order to ensure that this store of the vitamin is kept at a healthy level. […] In the UK, pernicious anaemia is the most common cause of vitamin B12 deficiency. Pernicious anaemia is an autoimmune disease that affects your stomach.

• #2 Pernicious Anemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/204930-overview

  Pernicious anemia is the most common cause of severe vitamin B12 deficiency worldwide and is due to autoimmune destruction of parietal cells and/or intrinsic factor. […] Cobalamin deficiency may result from dietary insufficiency of vitamin B12; disorders of the stomach, small bowel, and pancreas; certain infections; and abnormalities of transport, metabolism, and utilization. […] Classic pernicious anemia produces cobalamin deficiency due to failure of the stomach to secrete intrinsic factor. […] In adults, pernicious anemia is associated with severe gastric atrophy and achlorhydria, which are irreversible. […] Cobalamin deficiency may result from inadequate dietary intake, atrophy or loss of gastric mucosa, functionally abnormal intrinsic factor, inadequate proteolysis of dietary cobalamin, insufficient pancreatic protease, bacterial overgrowth in the intestine, and disorders of ileal mucosa.

• #2 Evaluation of Macrocytosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0201/p203.html

  Macrocytosis, generally defined as a mean corpuscular volume greater than 100 fL, is frequently encountered when a complete blood count is performed. The most common etiologies are alcoholism, vitamin B12 and folate deficiencies, and medications. […] When the peripheral smear indicates megaloblastic anemia (demonstrated by macroovalocytes and hypersegmented neutrophils), vitamin B12 or folate deficiency is the most likely cause. […] In recent years, an association has been found between Helicobacter pylori infection and vitamin B12 deficiency. […] Megaloblastic processes are characterized on the peripheral smear by macroovalocytes and hypersegmented neutrophils, which are absent in nonmegaloblastic macrocytic processes. […] In megaloblastic processes, erythrogenic precursors are larger than mature red blood cells (RBCs) because folate and vitamin B12 deficiencies result in defective RNA and DNA syntheses.

• #2 Vitamin B12 Deficiency – Nutritional Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-b12-deficiency

  Dietary vitamin B12 deficiency usually results from inadequate absorption, but deficiency can develop in vegans who do not take vitamin supplements. Deficiency causes megaloblastic anemia, damage to the white matter of the spinal cord and brain, and peripheral neuropathy. Diagnosis is usually made by measuring serum vitamin B12 levels. The Schilling test helps determine etiology. Treatment consists of oral or parenteral vitamin B12. Folate (folic acid) should not be used instead of vitamin B12 because folate may alleviate the anemia but allow neurologic deficits to progress. […] Vitamin B12 deficiency can result from inadequate intake, inadequate absorption, decreased utilization, and use of certain medications. […] Inadequate vitamin B12 absorption is the most common cause of deficiency. In older adults, inadequate absorption most commonly results from decreased acid secretion. Inadequate absorption may occur in small intestinal bacterial overgrowth or fish tapeworm infestation; in these cases, bacteria or parasites use ingested vitamin B12 so that less is available for absorption.

• #2 B12 deficiency anemia: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/b12-deficiency-anemia

  Some common causes of vitamin B12 deficiency anemia include: […] Pernicious anemia is an autoimmune condition that affects the lining of the stomach and prevents the production of a protein called intrinsic factor. […] Chronic inflammation of the stomach lining, or chronic gastritis, can prevent the secretion of intrinsic factor and stomach acids, which play a key role in helping the body absorb vitamin B12. […] Some surgeries, such as gastric bypass or small bowel resection, may involve rearranging or removing parts of the gastrointestinal tract. […] Long-term use of certain medications may also prevent the body from absorbing vitamin B12 and lead to a deficiency. […] Vitamin B12 is only present in animal-based foods. People who have diets low in these foods, such as vegan and vegetarian diets, may not consume enough vitamin B12 and become deficient.

• #2 Vitamin B12 Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441923/

  Vitamin B12 deficiency has 4 primary etiologies: […] Autoimmune: Pernicious anemia is an autoimmune condition in which antibodies to intrinsic factors are produced. Anti-intrinsic factor antibodies bind to and inhibit the effects of intrinsic factors, resulting in an inability of B12 to be absorbed by the terminal ileum. […] Malabsorption: Parietal cells in the stomach produce intrinsic factors; therefore, any patient with a history of gastric bypass surgery may be at risk for developing a B12 deficiency because their new alimentary pathway bypasses the site of intrinsic factor production. In patients with normal intrinsic factor production, any damage to the terminal ileum, such as surgical resection due to Crohn’s disease, will impair the absorption of B12 and lead to a deficiency. Other damage to the small intestine, such as inflammation from celiac disease or infection with the tapeworm Diphyllobothrium latum, may also result in a B12 deficiency.

• #2 Vitamin B12 Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441923/

  Dietary insufficiency: Vitamin B12 is stored in excess in the liver; however, patients who have followed a strict vegan diet for approximately 3 years may develop a B12 deficiency from a lack of dietary intake. […] Toxin exposure: Exposure to nitrous oxide can cause vitamin B12 deficiency and neurologic symptoms. Metformin treatment can cause B12 deficiency.

• #2 Vitamin B12 Deficiency Anemia: Symptoms, Causes, Treatments

  https://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia

  This type of anemia means that your body doesn’t have enough healthy red blood cells because you’re low in vitamin B12. […] You can have vitamin B12 deficiency anemia if you don’t get enough vitamin B12 in your diet from foods like milk, eggs, and meat, or if your body can’t absorb B12 because of a health problem. […] This is the most common cause of vitamin B12 deficiency worldwide and mainly affects people of Northern European ancestry. […] Vitamin B12 is only found in animal products like meat, eggs, and milk. So if you’re on a vegan or vegetarian diet where you’re not eating foods from animals, you’re at risk for B12 deficiency. […] If you have a stomach or small intestine condition such as celiac disease or Crohn’s disease, you may not be able to absorb enough vitamin B12 from food.

• #2 Vitamin B12 Deficiency: Signs, Causes and Treatments | Ada

  https://ada.com/conditions/vitamin-b12-deficiency/

  Pernicious anemia is a common cause of vitamin B12 deficiency. […] In order for vitamin B12 to be absorbed by the body, it needs to be combined with a protein called intrinsic factor in the stomach. This protein is produced by cells in the stomach lining. In people with pernicious anemia, the bodys immune system mistakenly attacks these cells, preventing intrinsic factor from combining with vitamin B12 and hampering its absorption. […] People who have certain conditions that affect the stomach and intestines, or have had certain types of surgery, may be at risk of vitamin B12 deficiency. […] Some medicines can interfere with the absorption of vitamin B12, potentially leading to a deficiency if precautions are not taken. […] Though fairly uncommon, some people may develop vitamin B12 deficiency as a result of low levels in their daily diet.

• #2

  https://111.wales.nhs.uk/encyclopaedia/a/article/anaemia,vitaminb12andfolatedeficiency

  Some types of medicine can lead to a reduction in the amount of vitamin B12 in your body. […] Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. […] Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol, and people following a restrictive diet that does not involve eating good sources of folate. […] Sometimes your body may be unable to absorb folate as effectively as it should. […] A lack of folate during pregnancy may increase the risk of the baby being born prematurely (before the 37th week of pregnancy) or having a low birth weight. […] A lack of vitamin B12 (with or without anaemia) can cause complications. […] A lack of folate (with or without anaemia) can also cause complications.

• #2 Vitamin B12 deficiency – Wikipedia

  https://en.wikipedia.org/wiki/Vitamin_B12_deficiency

  Vitamin B12 deficiency can lead to anemia, neurologic, and digestive dysfunctions. […] A late finding type of anemia known as megaloblastic anemia is often but not always present. […] Causes are usually related to conditions that give rise to malabsorption of vitamin B12 particularly autoimmune gastritis in pernicious anemia. […] Other conditions giving rise to malabsorption include surgical removal of the stomach, chronic inflammation of the pancreas, intestinal parasites, certain medications such as long-term use of proton pump inhibitors, H2-receptor blockers, and metformin, and some genetic disorders. […] Deficiency can also be caused by inadequate dietary intake such as with the diets of vegetarians, and vegans, and in the malnourished. […] Deficiency may be caused by increased needs of the body for example in those with HIV/AIDS, and shortened red blood cell lifespan.

• #2

• #2 Vitamin B-12 Deficiency Anemia

  https://johnshopkinshealthcare.staywellsolutionsonline.com/MentalHealth/85,P00080

  Risk factors for vitamin B-12 deficiency anemia include: […] A family history of the disease […] Surgery that removes part or all of your stomach or intestine […] Autoimmune diseases, including type 1 diabetes […] Crohn’s disease […] HIV […] Some medicines […] Strict vegetarian or vegan diets […] Older age […] Symptoms include weak muscles, numbness, trouble walking, nausea, weight loss, irritability, fatigue, and increased heart rate. […] Treatment may include vitamin B-12 supplements. It is also important to eat a well-balanced diet that is rich in Vitamin B-12.

• #2 Folate Deficiency Anemia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24196-folate-deficiency-anemia

  Folate deficiency anemia results from not having enough folate (vitamin B9) in your body. […] Folate deficiency anemia can occur if you dont get enough folate in your diet. Other causes include conditions that prevent your body from absorbing or using folate, such as: […] Healthcare providers have linked folate deficiency to congenital conditions (present at birth), especially neural tube defects such as spina bifida. […] Risk factors for folate deficiency anemia include: […] Folate is a nutrient thats essential for the development of healthy red blood cells. When your body doesnt have enough folate, your bone marrow produces unusually large red blood cells called megaloblasts. […] Because vitamin B12 deficiency and folate deficiency can occur together, providers will also usually do a vitamin B12 blood test.

• #2 Vitamin Deficiency Anemia: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17732-vitamin-deficiency-anemia

  Vitamin deficiency anemia is a condition that develops when you have low levels of vitamin B12 or B9 (folate). In this type of anemia, your body doesn’t produce enough healthy red blood cells. […] Vitamin deficiency anemia is a condition in which your body doesn’t produce enough healthy red blood cells. It happens primarily when you have low levels of vitamin B12 or B9 (folate or folic acid). […] Both vitamins are crucial in many processes in your body, including making red blood cells. Without enough B12 or folic acid, your body doesn’t make normal red blood cells and those cells die more quickly than normal cells so they can’t carry oxygen to all of your body tissues. This lack of normal red blood cells is anemia. […] Vitamin deficiency anemia occurs when you have low vitamin B12 or folate levels. Causes of vitamin deficiency anemia may include: Certain medications, such as some anti-seizure drugs. Excessive alcohol use. Health conditions that affect nutrient absorption. History of gastric surgery. Intestinal problems such as tapeworms. Diet that doesn’t include adequate meats/fish, dairy products, eggs, or specific vegan options (B12) or dark green veggies, beans, nuts, seeds (folate). […] You are also at a higher risk of a folate deficiency if you are: Breastfeeding. Pregnant. On dialysis for kidney disease.

• #2 Anaemia, vitamin B12 or folate deficiency – Causes of vitamin B12 or folate

  https://www.ibdrelief.com/learn/complications-of-ibd/vitamin-and-mineral-deficiencies-in-ibd/vitamin-b12-and-ibd/anaemia-vitamin-b12-or-folate-deficiency-causes-of-vitamin-b12-or-folate-deficiency-anaemia

  Some types of medicine can lead to a reduction in the amount of vitamin B12 in your body. […] Some people can experience problems related to a vitamin B12 deficiency, despite appearing to have normal levels of vitamin B12 in their blood. […] Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. […] Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol and people following a fad diet that doesn’t involve eating good sources of folate. […] Sometimes your body may be unable to absorb folate as effectively as it should. […] Some types of medicine reduce the amount of folate in your body, or make the folate harder to absorb. […] Your body sometimes requires more folate than normal. […] If you are pregnant or trying to get pregnant, it is recommended that you take a 400 microgram folic acid tablet every day until you are 12 weeks pregnant.

• #2 Anaemia, vitamin B12 and folate deficiency | Nursing Times

  https://www.nursingtimes.net/archive/anaemia-vitamin-b12-and-folate-deficiency-06-02-2009/

  If your anaemia is being caused by a vitamin B12 deficiency, you may also notice other symptoms, including: […] A folate deficiency may also cause: […] Folate deficiency anaemia can also develop for a number of reasons, some of which are outlined below. […] Some people do not have enough folate in their daily diet. […] Sometimes, your body may be unable to absorb folate as effectively as it should. […] You may lose folate if you have to urinate very frequently because of an underlying condition that affects your kidney or liver, or other organs. […] Sometimes, your body requires more folate than normal. […] If you are pregnant, you should take a daily supplement of 0.4mg of folic acid for the first 12 weeks of your pregnancy. […] If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you will be prescribed vitamin B12 tablets.

• #2 Folate-deficiency anemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000551.htm

  Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate. Folate is a type of B vitamin. It is also called folic acid. […] Causes of this type of anemia include: Too little folic acid in your diet, Hemolytic anemia, Long-term alcoholism, Use of certain medicines (such as phenytoin [Dilantin], methotrexate, sulfasalazine, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole, and barbiturates). […] The following raise your risk for this type of anemia: Alcoholism, Eating overcooked food, Poor diet (often seen in the poor, the older people, and people who do not eat fresh fruits or vegetables), Pregnancy, Weight loss diets. […] Folic acid is needed to help a baby in the womb grow properly. Too little folic acid during pregnancy may lead to birth defects in a baby.

• #2 3.7 Vitamin B12 and Folate Deficiency Anemia – Health Alterations

  https://wtcs.pressbooks.pub/healthalts/chapter/3-7-vitamin-b12-and-folate-deficiency-anemia/

  Decreased Absorption of Vitamin B12: Some people may consume adequate amounts of vitamin B12 but have issues with absorbing this vitamin. Risk factors for decreased absorption of vitamin B12 are a gastric bypass, Crohns disease or other inflammatory bowel disorder, chronic use of antacids or proton pump inhibitors (PPIs), chronic H. Pylori infection, gastric cancer, chronic use of metformin, and chronic excess alcohol intake. […] Autoimmune Disorder: Pernicious anemia is a specific type of vitamin B12 anemia. Pernicious anemia is an autoimmune disorder in which antibodies are formed that attack the stomach cells that produce intrinsic factor. […] Folate deficiency has become less common because food has been routinely supplemented with folic acid, but risk factors are similar to vitamin B12 deficiency. People who do not consume a varied, nutrient-rich diet are at risk for folate deficiency. For example, people with restrictive diets, anorexia nervosa, or those with excessive chronic alcohol use and a limited diet are at risk. Gastric bypass and inflammatory bowel disorders, as well as chronic medications such as methotrexate, antiseizure medications, and certain antibiotics, can also impact the absorption of folate.

• #2 Folate, iron and vitamin B6 | Pernicious Anaemia Society

  https://pernicious-anaemia-society.org/folic-acid-iron-and-vitamin-b6/

  There are two vitamins that are important in connection with vitamin B12: folate and vitamin B6. […] A deficiency of folate can cause anaemia, intestinal disorders, fatigue, depression and birth defects. […] Anaemia is often caused by an iron deficiency, but can also be caused by a deficiency of vitamin B12, B6 and/or folate. […] The effect of vitamin B12 is closely intertwined with that of folate, but these two vitamins are not interchangeable. […] When anaemia caused by a vitamin B12 deficiency (temporarily) disappears after the administration of folic acid, the premature conclusion is sometimes drawn that there was (only) a folic acid deficiency. […] Neurological symptoms resulting from a vitamin B12 deficiency can be exacerbated by the administration of folic acid, resulting in nerve damage that can become permanent. […] Vitamin B6, together with vitamin B12 and folate, is necessary for normalizing homocysteine levels. […] The symptoms of vitamin B6 deficiency include nervous system disorders, anaemia, loss of appetite, diarrhea, depression, skin problems, confusion, reduced resistance and glossitis.

• #2 Severe megaloblastic anemia: Vitamin deficiency and other causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/3/153

  Nearly every step of this pathway can be disrupted in various pathologic states, but lack of intrinsic factor secondary to pernicious anemia is the cause of vitamin B12 deficiency in most cases. […] Chronic atrophic autoimmune gastritis affects the body and fundus of the stomach, replacing normal oxyntic mucosa with atrophic-appearing mucosa, often with associated intestinal metaplasia. […] The laboratory and clinical findings were consistent with vitamin B12 deficiency, and the presence of anti-intrinsic factor antibody confirmed the diagnosis of pernicious anemia. […] Vitamin B12 deficiency causes hematologic and neuropsychiatric manifestations that may occur together or independently. […] Megaloblastic anemia due to folate deficiency and other causes shares the same hematologic manifestations as vitamin B12 deficiency but lacks the neurologic features.

• #2 3.7 Vitamin B12 and Folate Deficiency Anemia – Health Alterations

  https://wtcs.pressbooks.pub/healthalts/chapter/3-7-vitamin-b12-and-folate-deficiency-anemia/

  Vitamin B12 and folate are water-soluble vitamins required for the production of red blood cells, white blood cells, and platelets. A deficiency of either of these vitamins causes megaloblastic anemia (also called macrocytic anemia) because the red blood cells in these disorders are abnormally large when compared to a healthy red blood cell. […] There are three basic causes of vitamin B12 anemia, including dietary deficiency, decreased absorption of vitamin B12, and an autoimmune disorder called pernicious anemia. […] Dietary Deficiency: Individuals who follow a strict vegetarian (vegan) diet and do not eat animal products are at risk for not consuming enough vitamin B12 in their daily diet and often require vitamin supplements. Additionally, people of low socioeconomic status may not be able to afford animal proteins that contain Vitamin B12.

• #2 Severe megaloblastic anemia: Vitamin deficiency and other causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/3/153

  The most common hematologic manifestation is megaloblastic anemia, which includes macrocytic erythrocytes in the peripheral blood and megaloblastic precursor cells in the bone marrow that exhibit nuclear-to-cytoplasmic dyssynchrony. […] Symptoms secondary to anemia include fatigue, shortness of breath, and poor exercise tolerance. […] Vitamin B12 deficiency can cause subacute combined degeneration of the dorsal and lateral columns of the spinal cord.

• #2 Evaluation of Macrocytosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0201/p203.html

  The normal range for serum measures of vitamin B12 varies among laboratories. If the vitamin B12 level is borderline low (i.e., 100 to 400 pg per mL [74 to 295 pmol per L]), methylmalonic acid and homocysteine levels should be ordered and, if elevated, may provide evidence of B12 deficiency. […] The history of folate deficiency may mimic the history of vitamin B12 deficiency in regard to poor nutritional intake or absorption. […] Some medications that are used to treat seizure disorders, cancer, and autoimmune diseases can lead to folate deficiency. […] RBC folate levels more accurately correlate with folate stores and should be performed if folate deficiency is suspected. […] In differentiating the cause of megaloblastic anemia, a methylmalonic acid level that is within normal range also points toward a diagnosis of folate deficiency, especially if the serum vitamin B12 level is within the normal range.

• #2 Signs and Symptoms of Vitamin B12 Deficiency

  https://www.healthline.com/nutrition/vitamin-b12-deficiency-symptoms

  Vitamin B12 deficiency is determined as follows (2): […] Studies suggest that up to 20% of people over the age of 60 in the United States and the United Kingdom are deficient in the vitamin. This is often due to limited dietary intake, malabsorption, medical conditions, or the use of B12-depleting medications (2, 3, 4, 5). […] Because the ability to absorb B12 from food declines with age, deficiency is more common in older adults. […] B12 deficiency is often misdiagnosed, often due to inadequate laboratory testing or because the symptoms are not specific (7). […] Specifically, a deficiency in B12 can cause megaloblastic anemia. This condition leads to the formation of large, abnormal, and immature red blood cells and impaired DNA synthesis (2, 9). […] Like the condition called iron deficiency anemia, anemia related to B12 deficiency may make your skin pale due to a lack of fully-matured, healthy red blood cells in the body (2).

• #2 Folic Acid Deficiency: Causes, Symptoms, and Treatment

  https://patient.info/allergies-blood-immune/anaemia-leaflet/folic-acid-deficiency-anaemia

  A normal balanced diet contains enough folic acid. However, a folic acid deficiency may cause anaemia and sometimes other symptoms. […] Folic acid deficiency is a lack of folic acid in the blood. Folic acid (also known as folate) is a B vitamin and is needed to make new cells in your body, including red blood cells. Your body does not store very much folic acid. You need a regular fresh supply to keep healthy. If you do not have enough folic acid you may become anaemic. […] This is the most common cause. This occurs most often in elderly people who do not eat well. Alcohol-dependent people are another group often not eating properly. […] Pregnancy causes reserves of folic acid in your body to be used by the growing baby. You are at risk of becoming low in folic acid during the later stages of pregnancy, particularly if you do not eat well during pregnancy.

• #2 Vitamin deficiency anemia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vitamin-deficiency-anemia/diagnosis-treatment/drc-20355031

  To help diagnose vitamin deficiency anemias, you might have blood tests that check for: […] The amount of vitamin B-12 and folate in the blood. […] Vitamin deficiency anemia is treated with doses of whichever vitamin is lacking. […] For pernicious anemia, vitamin B-12 is usually delivered via injection and may need to be taken regularly for the rest of your life. […] Medications to boost folate levels usually come as pills to be swallowed, but some versions can be delivered through a narrow, flexible tube into a vein (intravenously). […] Causes and pathophysiology of vitamin B12 and folate deficiency.

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