Materiały źródłowe

• #1

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

  The treatment for vitamin B12 or folate deficiency anaemia depends on what’s causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins. […] Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, called hydroxocobalamin. […] If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be advised to take vitamin B12 tablets every day between meals. […] If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, you’ll usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of your life. […] To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. […] Most people need to take folic acid tablets for about 4 months. But if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer, possibly for life. […] Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they’re normal.

• #2 Vitamin B12 & folate anaemia | NHS inform

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

  Most cases of vitamin B12 and folate deficiency can be easily treated with injections or tablets to replace the missing vitamins. […] Vitamin B12 supplements are usually given by injection at first. Then, depending on whether your B12 deficiency is related to your diet, you’ll either require B12 tablets between meals or regular injections. These treatments may be needed for the rest of your life. […] Folic acid tablets are used to restore folate levels. These usually need to be taken for four months. […] To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake. […] Most people need to take folic acid tablets for about four months. However, if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer possibly for life.

• #3 Cobalamin (vitamin B12) and Folate Deficiency – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/vitamin-b12

  This guideline covers the primary care investigation and management of cobalamin (vitamin B12 or simply B12) and folate deficiency in adults. […] Consider B12 supplementation without testing in asymptomatic patients with risk factors for B12 deficiency. […] Folate testing is rarely indicated but may be available via consultation with the laboratory medicine physician or scientist. […] A daily multivitamin containing B12 and folic acid is recommended for all people who could become pregnant, especially those with a vegan diet. […] In suspected B12 deficiency, supplement both B12 and folate. […] Early treatment of B12 deficiency is particularly important because neurologic symptoms may be irreversible. Oral administration is extremely effective and less invasive compared to other routes.

• #4 Vitamin B12 or Folate Deficiency Anaemia – Oakwood Medical Centre

  https://practice365.co.uk/n81067/clinics-and-services/vitamin-b12-or-folate-deficiency-anaemia/

  The treatment for vitamin B12 or folate deficiency anaemia depends on whats causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins. […] Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, called hydroxocobalamin. […] After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet or whether the deficiency is causing any neurological problems, such as problems with thinking, memory and behaviour. […] If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be advised to take vitamin B12 tablets every day between meals, which can be bought over the counter at any pharmacy. […] If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, youll usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of your life.

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

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

  Vitamin B12 deficiency can be treated with intramuscular injections of cyanocobalamin or oral vitamin B12 therapy. Approximately 10% of the standard injectable dose of 1 mg is absorbed, which allows for rapid replacement in patients with severe deficiency or severe neurologic symptoms. Guidelines from the British Society for Haematology recommend injections three times per week for two weeks in patients without neurologic deficits. If neurologic deficits are present, injections should be given every other day for up to three weeks or until no further improvement is noted. […] A 2005 Cochrane review involving 108 patients with vitamin B12 deficiency found that high-dose oral replacement (1 mg to 2 mg per day) was as effective as parenteral administration for correcting anemia and neurologic symptoms. However, oral therapy does not improve serum methylmalonic acid levels as well as intramuscular therapy, although the clinical relevance is unclear. […] The British Society for Haematology recommends intramuscular vitamin B12 for severe deficiency and malabsorption syndromes, whereas oral replacement may be considered for patients with asymptomatic, mild disease with no absorption or compliance concerns.

• #6 Vitamin B12 or folate deficiency anaemia – Treatment | Health Information from Winer Chemist

  https://winerchemist.co.uk/nhs_conditions_vitamin-b12-or-folate-deficiency-anaemia_treatment

  The treatment for vitamin B12 or folate deficiency anaemia depends on what’s causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins. […] Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, called hydroxocobalamin. At first, you’ll have these injections every other day for 2 weeks or until your symptoms have started improving. Your GP or nurse will give the injections. After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet or whether the deficiency is causing any neurological problems, such as problems with thinking, memory and behaviour. […] If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be advised to take vitamin B12 tablets every day between meals. Or you may need to have an injection of hydroxocobalamin twice a year. People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.

• #7 Vitamin B12 or folate deficiency anaemia – Treatment | Health Information from Winer Chemist

  https://winerchemist.co.uk/nhs_conditions_vitamin-b12-or-folate-deficiency-anaemia_treatment

  If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, you’ll usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of your life. If you have had neurological symptoms that affect your nervous system, such as numbness or tingling in your hands and feet, caused by a vitamin B12 deficiency, you’ll be referred to a haematologist and may need to have injections every 2 months. […] To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake. Most people need to take folic acid tablets for about 4 months. But if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer, possibly for life.

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

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

  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. […] Vitamin B-12 is available as: Injections into a muscle or under the skin, Pills to be swallowed, A liquid or tablet that dissolves under the tongue, Nose gel or sprays. […] 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).

• #9 Vitamin B12 Deficiency: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22831-vitamin-b12-deficiency

  Vitamin B12 deficiency can be treated with vitamin B12 medications. […] Vitamin B12 deficiency can be treated with vitamin B12. It’s often treated with cyanocobalamin, a human-made form of vitamin B12. Depending on the cause of the deficiency, you may only need treatment until your vitamin B12 levels are back to normal, or you may need vitamin B12 therapy for the rest of your life. Options for vitamin B12 treatment include: Vitamin B12 oral medication. Vitamin B12 intramuscular injections (a shot that goes into your muscle). Vitamin B12 nasal gel. Vitamin B12 nasal spray.

• #10 Megaloblastic Anemia Treatment & Management: Approach Considerations, Cobalamin Therapy, Folate Therapy

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

  Folate should be administered orally. If this is difficult, comparable doses can be administered parenterally. […] The dosage range for folate is 1 to 5 mg daily; 1 mg/d is the usual dosage for adults with megaloblastic anemia, while a higher dosage is indicated in hemolysis, malabsorption, alcoholism, and exfoliative dermatitis. […] Folate therapy has been recommended in patients with hyperhomocysteinemia who are at risk for thromboembolic complications. […] Folate therapy should not be instituted in a patient with megaloblastic anemia if cobalamin deficiency has not been definitively ruled out. The danger is that folic acid will improve the anemia but not the neurological complications of cobalamin deficiency, and the neurological disorder will worsen. Both cobalamin and folate should be given if cobalamin deficiency has not been ruled out.

• #11 Vitamin B12 or Folate Deficiency Anaemia – Oakwood Medical Centre

  https://practice365.co.uk/n81067/clinics-and-services/vitamin-b12-or-folate-deficiency-anaemia/

  To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. […] Most people need to take folic acid tablets for about 4 months. But if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer, possibly for life. […] Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure theyre normal. […] If a vitamin B12 deficiency is not detected and treated, it could affect your nervous system.

• #12 Vitamin B12 or folate deficiency anaemia – Treatment | Health Information from Winer Chemist

  https://winerchemist.co.uk/nhs_conditions_vitamin-b12-or-folate-deficiency-anaemia_treatment

  Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they’re normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency. If a vitamin B12 deficiency is not detected and treated, it could affect your nervous system.

• #13 Treatment of folate deficiency – Primary Care Notebook

  https://primarycarenotebook.com/pages/haematology/folate-deficiency/treatment-of-folate-deficiency

  Blood transfusion for folate deficiency is rarely indicated except in severe anaemia or where other causes of anaemia, such as bleeding, coexist. […] Folic acid should not be used alone for pernicious anaemia and other vitamin B12 deficiency states because this may precipitate subacute combined degeneration of the cord. […] it is important that serum B12 levels are normal because treatment with folic acid can precipitate subacute combined degeneration of the cord.

• #14 B12 deficiency – RefHelp

  https://apps.nhslothian.scot/refhelp/guidelines/haematology/b12deficiency/

  Repeat FBC and reticulocyte count at 8 weeks. The mean cell volume (MCV) should be normalising, and reticulocyte count rising. If reticulocyte count still low see refhelp macrocytosis guideline as may need haem referral. […] For people with mild sensory symptoms not responding to IM treatment it is unlikely that the symptoms were due to B12 deficiency. Consider alternative explanations and discontinue alt day IM treatment after 2 weeks. Maintenance may then be via the oral route unless there is a specific indication to give IM such as pernicious anaemia/ malabsorption. […] If combined B12 and folate deficiency always start B12 24 hours ahead of folate Seek specialist advice only if symptoms are severe, there is diagnostic uncertainty and a neurology opinion is required to help determine the cause.

• #14 B12 deficiency – RefHelp

  https://apps.nhslothian.scot/refhelp/guidelines/haematology/b12deficiency/

  Covid-19 prompted the British Society of Haematology to issue pandemic B12 guidance, and this outlines some of the principles for moving to oral B12 preparations. […] If patient is anaemic or macrocytic request Reticulocyte count and folate to help differentiate causes and as a baseline for assessing immediate response to treatment. […] Note that in severe B12 or Folate deficiency supplementation may cause severe hypokalaemia as red cell reproduction restarts and a UE check after starting treatment may be appropriate. […] Check reticulocyte count again within 7-10 days of starting treatment if initial Haemoglobin and reticulocytes low. An increase in the reticulocyte count to above the normal range indicates that treatment is having a positive effect and red blood cell production is appropriately increasing.

• #15 Pernicious Anaemia and B12 Deficiency | Doctor

  https://patient.info/doctor/pernicious-anaemia-and-b12-deficiency

  Response to treatment of vitamin B12 deficiency can vary and depends on the cause of the vitamin B12 deficiency. Symptoms may start to improve within 2 weeks, but this may take up to 3 months. It can take much longer for symptoms to disappear altogether. Symptoms may get worse initially during treatment. […] Lifelong intramuscular vitamin B12 replacement if: autoimmune gastritis is the cause, or suspected cause, of vitamin B12 deficiency, or they have had a total gastrectomy, or a complete terminal ileal resection. […] If vitamin B12 deficiency because of malabsorption that is not caused by autoimmune gastritis, or a total gastrectomy or complete terminal ileal resection (eg, malabsorption caused by coeliac disease, partial gastrectomy or some forms of bariatric surgery): vitamin B12 replacement and consider intramuscular instead of oral vitamin B12 replacement (oral dose should be at least 1 mg a day).

• #16 B12 deficiency – RefHelp

  https://apps.nhslothian.scot/refhelp/guidelines/haematology/b12deficiency/

  B12 neurological symptoms typically take several months to improve and may not recover completely even with replacement. We suggest waiting at least 3 months for a clinical response. […] In adults it is prudent to give intramuscular replacement initially, but then move to oral, or no, B12 supplementation once the anti-tTG has normalised. […] Patients who have undergone gastric bypass will require 3 monthly intramuscular injections of vitamin B12. […] Patients who have undergone sleeve gastrectomy surgery or duodenal switch are usually recommended to have initial 3 monthly intramuscular injections of vitamin B12 but may need less frequent injections depending on blood results, however, they should always be given IM rather than oral treatment. […] Individuals with pernicious anaemia or significant neurological symptoms with a clear response to IM B12 treatment should usually continue on IM B12 treatment lifelong. […] Upon treatment discontinuation or a switch from IM to oral treatment it is therefore important to consider whether or not it is appropriate to recheck B12 levels after 6 months, and potentially annually for up to 5 years to allow time for liver stores to become depleted.

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

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

  If your doctor diagnoses you with vitamin B12deficiency anemia, your treatment will depend on the cause and seriousness of your condition. Some people need lifelong treatment. […] Different therapies can be used to treat anemia. […] Vitamin B12 medicine can be prescribed by your provider for you to take by mouth or as a nose spray or a shot. These supplements can help increase the levels of vitamin B12 in your body. For serious vitamin B12deficiency anemia, your doctor may recommend vitamin B12 shots until your levels are healthy. […] Blood transfusions to treat serious vitamin B12deficiency anemia in combination with vitamin B12 treatment. […] Your care provider may also recommend you make some changes to your eating habits to help increase the amount of vitamin B12 in your diet. […] Some symptoms may take months to improve, depending on how serious they are. Some symptoms related to the brain or the nerves, such as numbness and tingling, may not go away even with treatment.

• #18 Cobalamin (vitamin B12) and Folate Deficiency – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/vitamin-b12

  Vitamin B12 deficiency is associated with either long-term proton inhibitor (PPI) or Histamine-2 receptor blocker (H2 blocker) use, but a causal relationship is not established. […] Refer to Table 6: Treatment of folate deficiency below for folate deficiency treatment options and the SOGC Guideline No. 427: Folic Acid and Multivitamin Supplementation for Prevention of Folic Acid-Sensitive Congenital Anomalies for more information. […] Patients with pernicious anemia require lifelong therapy, while patients with malabsorption require treatment until underlying condition or diet is corrected.

• #19 Appropriate use of tests for folate and vitamin B12 deficiency – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/appropriate-use-of-tests-for-folate-and-vitamin-b12-deficiency.html

  A full blood count which shows anaemia and macrocytosis should prompt the practitioner to look for a deficiency of vitamin B12 or folate. […] Following the identification of folate or B12 deficiency, a cause must be sought. […] Untreated, deficiency of folate or B12 may lead to severe anaemia, and in B12 deficiency, crippling neurological disease. […] The clinical significance of serum B12 levels that are only mildly reduced or in the region of 150-200 pmol/L may be difficult to determine. The presence of any haematological or neuropsychiatric evidence of B12 deficiency would indicate true B12 depletion and the need for B12 therapy. […] After folate or B12 deficiency has been identified by suitable tests, a cause for the deficiency must be sought. Folate deficiency is commonly the result of under nutrition or malnutrition in association with increased demand (e.g. pregnancy). […] Pernicious anaemia is the most important syndrome of B12 deficiency. The diagnosis identifies the need for lifelong B12 treatment and the maintenance of a high index of suspicion for complications such as carcinoma of the stomach.

• #20

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

  Most cases of vitamin B12 and folate deficiency can be easily treated with injections or tablets to replace the missing vitamins. […] Vitamin B12 supplements are usually given by injection at first. […] Then, depending on whether your B12 deficiency is related to your diet, you’ll either require B12 tablets between meals or regular injections. […] Treatments may last until your vitamin B12 levels have improved or you may need treatment for the rest of your life. […] Folic acid tablets are used to restore folate levels. These usually need to be taken for 4 months. […] In some cases, improving your diet can help treat the condition and prevent it coming back.

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

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

  Good sources of vitamin B12 are meat, eggs and dairy products. If you incorporate foods like this into a healthy, balanced diet, you should be able to increase your vitamin B12 intake. […] The best way to increase your intake of folate is to eat more green vegetables. Vegetables, such as broccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice all contain naturally high levels of folate. […] To ensure that your treatment is working, your vitamin B12 and folate levels will have to be monitored. Shortly after starting treatment, you will need to have a blood test to check that your treatment is starting to help restore your vitamin B12 and folate levels. You will then need another blood test after approximately eight weeks to confirm that your treatment has been successful.

• #22 Pernicious Anaemia and B12 Deficiency | Doctor

  https://patient.info/doctor/pernicious-anaemia-and-b12-deficiency

  When offering oral vitamin B12 replacement in pregnancy or during breastfeeding, consider a dosage of at least 1 mg a day. […] Offer vitamin B12 replacement, and consider oral instead of intramuscular vitamin B12 replacement and review response to treatment at the person’s first follow-up appointment. […] Offer an initial follow-up appointment to people who are having vitamin B12 replacement at 3 months after they started treatment, or earlier depending on severity of symptoms, or at 1 month after they started treatment if they are pregnant or breastfeeding.

• #23 Vitamin B12 deficiency: treatment during pregnancy – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice

  https://www.sps.nhs.uk/articles/vitamin-b12-deficiency-treatment-during-pregnancy/

  Intramuscular hydroxocobalamin and oral cyanocobalamin are treatment options for the management of clinically relevant vitamin B12 deficiency during pregnancy. […] NICE CKS: Management of anaemia vitamin B12 and folate deficiency provides advice on the management of vitamin B12 deficiency. The guideline discusses when to refer, dosing and monitoring during pregnancy. […] Prescribers should seek urgent advice from a haematologist when treating vitamin B12 deficiency anaemia during pregnancy. […] Hydroxocobalamin and cyanocobalamin are naturally occurring analogues of vitamin B12 used in the treatment of vitamin B12 deficiency. […] Consider intramuscular hydroxocobalamin if specialist advice is not immediately available. Administer 1mg daily on alternative days until no further improvement, then 1mg every 2 months.

• #24 Pernicious Anemia Treatment & Management: Approach Considerations, Cobalamin Therapy, Blood Transfusions

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

  Limited studies have shown that adequate therapy can be maintained after the initial parenteral loading doses through oral ingestion of 250-1000 g of vitamin B12 daily. […] The oral route may be necessary in the rare patients who have allergic reactions to parenteral administration, or in patients receiving anticoagulant or antiplatelet agent therapy, in whom intramuscular injections are contraindicated. […] Transfusions are rarely required in patients with a megaloblastic anemia that is due to vitamin B12 deficiency. […] People who are strict vegetarians and, most particularly, people who do not consume eggs, milk, or meat can develop cobalamin deficiency. Counsel these people to either change their dietary habits or remain on supplementary vitamin B12 therapy for their lifetime. […] Elderly people are at risk for developing pernicious anemia due to achlorhydria. Therefore, serum vitamin B12 levels should be checked. If their levels are low or if cobalamin deficiency is suspected, they should be treated with vitamin B12 supplementation.

• #24 Pernicious Anemia Treatment & Management: Approach Considerations, Cobalamin Therapy, Blood Transfusions

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

  The following goals are the most important in establishing care for patients with pernicious anemia: […] If there is evidence for folic acid deficiency but pernicious anemia has not been ruled out, treat with both folic acid and cobalamin until pernicious anemia has been ruled out. The reason is that folic acid restores blood counts but does not prevent the development of subacute combined system degeneration in patients with pernicious anemia. […] Vitamin B12 is available for therapeutic use parenterally as either cyanocobalamin or hydroxocobalamin. The two forms are equally useful in the treatment of vitamin B12 deficiency, and both are nontoxic (except for rare allergic reactions). […] A number of regimens have been recommended. One regimen begins with daily subcutaneous administration for the first week. If significant reticulocytosis confirms that therapy is successful, doses are then administered twice weekly for another 4-5 weeks. After this period, 100 g can be administered monthly by subcutaneous or intramuscular injection.

• #25 Pernicious anemia – Wikipedia

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

  Pernicious anemia can be treated with injections of vitamin B12. […] If the symptoms are serious, frequent injections are typically recommended initially. […] There are not enough studies that pills are effective in improving or eliminating symptoms. […] Often, treatment may be needed for life. […] In some severe cases of anemia, a blood transfusion may be needed to resolve haematological effects. […] Treatment is lifelong. […] The treatment of PA varies by country and area.

• #26 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. […] Treatment depends on the cause of B12 deficiency anemia. The goal of treatment is to increase your vitamin B12 level. […] For people who have a low level of B12 due to a restricted vegetarian diet, taking B12 pills may resolve the issue. […] For people with a health condition that causes B12 deficiency, treatment may include a shot of vitamin B12, often once a month. If you have a very low level of B12, you may need more shots in the beginning. It is possible you may need shots regularly for the rest of your life. […] Vitamin B12 deficiency anemia most often responds well to treatment. It will likely get better when the underlying cause of the deficiency is treated.

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

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

  Folate deficiency anemia can occur when you dont have enough vitamin B9 in your diet. Treatment with a vitamin B9 supplement usually restores red blood cells and resolves symptoms. […] Vitamin B9 supplements are the main treatment. You usually take them by mouth. If you cant swallow pills, you may receive vitamin B9 through a shot or an intravenous (IV) line. Youll need to take supplements for at least several months. […] Treatment for folate deficiency anemia is usually successful. Within several months of taking or receiving vitamin B9 supplements, most people start producing healthy red blood cells again and their symptoms improve. […] Your healthcare provider will work with you to figure out whats causing your condition. Theyll recommend a vitamin B9 supplement and other treatment options if you have a condition thats causing folate deficiency anemia.

• #28 Vitamin B12 Deficiency | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0301/p979.html

  This distinction is now unnecessary, because evidence points to a B12 absorption pathway independent of intrinsic factor, and studies have proved that oral replacement is equal in efficacy to intramuscular therapy. […] Because most clinicians are generally unaware that oral vitamin B12 therapy is effective, the traditional treatment for B12 deficiency has been intramuscular injections. However, since as early as 1968, oral vitamin B12 has been shown to have an efficacy equal to that of injections in the treatment of pernicious anemia and other B12 deficiency states. […] The actual transport mechanism used in this pathway remains unproved, but vitamin B12 is thought to be absorbed en masse in high doses. […] Although the daily requirement of vitamin B12 is approximately 2 mcg, the initial oral replacement dosage consists of a single daily dose of 1,000 to 2,000 mcg. This regimen has been shown to be safe, cost-effective, and well tolerated by patients. […] After the diagnosis of vitamin B12 deficiency has been made and a treatment plan has been initiated, follow-up is important to determine the patient’s response to therapy.

• #29

  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. […] It’s important for vitamin B12 or folate deficiency anaemia to be diagnosed and treated as soon as possible. […] Most cases of vitamin B12 and folate deficiency can be easily treated with injections or tablets to replace the missing vitamins. […] Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, called hydroxocobalamin. […] To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. […] Most people need to take folic acid tablets for about 4 months. But if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer, possibly for life.

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