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Question answered:23/04/08
CKS has produced a guideline on anaemia- vitamin B12 and folate deficiency (1). On how to treat a person with vitamin B12 deficiency the guideline states:
· “Intramuscular hydroxocobalamin injection is the treatment of choice for vitamin B12 deficiency in the UK.
· For management of pregnant women with vitamin B12 deficiency, seek specialist advice from a haematologist (note: vitamin B12 deficiency anaemia in women of childbearing age is very rare).
· For people with neurological involvement:
o Seek specialist advice from a haematologist.
o Initially administer hydroxocobalamin 1 mg intramuscularly on alternate days until there is no further improvement, then administer hydroxocobalamin 1 mg intramuscularly every 2 months.
· For people with NO neurological involvement:
o Initially (whether the person is a vegan or not) administer hydroxocobalamin 1 mg intramuscularly on alternate days for 2 weeks.
o Maintenance dose, where the vitamin B12 deficiency is NOT thought to be diet related:
§ The standard dose is to administer hydroxocobalamin 1 mg intramuscularly every 3 months for the rest of the person's life. Note: the manufacturers' licence is for 1 mg every 2–3
months.
· Maintenance dose, where vitamin B12 deficiency is thought to be diet related:
o Advise people either to take oral cyanocobalamin tablets 50–150 micrograms daily between meals, or have a twice-yearly hydroxocobalamin 1 mg injection administered (the hydroxocobalamin injection regimen may be preferred in the elderly who are more likely to have malabsorption).
o In vegans this treatment may be needed for the rest of the person's life, whereas in other people with dietary deficiency, replacement treatment can be stopped once the vitamin B12 levels have been corrected and the diet has improved.
o Advise people to eat foods rich in vitamin B12. Foods which have been fortified with vitamin B12 (e.g. some soy products, and some breakfast cereals and breads) are good alternative sources to meat, eggs, and dairy products.”
The guideline also provides evidence on which the basis of the above recommendations is made. We would therefore suggest you read this section of the guideline.
- http://cks.library.nhs.uk/anaemia_b12_and_folate_deficiency/view_whole_topic_review
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