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05 May 2021

Günel Bayramova

Internal Medicine Specialist

B12 Vitamin Deficiency

B12 Vitamin Deficiency

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  • Where is Vitamin B12 found?
  • B12 is mostly found in animal foods. It is stored in the body in the liver. The reservoir in the liver is about 2-5 mg. Daily need for Vitamin B12 is 2.5-5 micrograms.


  • What are the causes of vitamin B12 deficiency?
  • The most common cause of B12 deficiency is pernicious anemia. It is forming the antibody cells against the abdominal tissue of the body. One of the other reasons is that the lack of B 12 intake is observed in vegetarians. And it takes 10-15 years for B12 deficiency to develop. Other causes of B12 deficiency are gastrectomy (3-5 years is required for anemia to develop), congenital intrinsic factor deficiency or defective synthesis, chronic pancreatitis, ZES syndrome, parasites (Diphyllobothrium latum), bacterial overgrowth, diseases affecting the terminal ileum, congenital selective B12 malabsorption (Imerslund - Grasbeck syndrome), transcobalamin II deficiency and NO2 abuse. Some drugs such as PAS, colchicine, metformin, ethanol, omeprazole, potassium chloride, zidovudine can also cause B12 deficiency.


  • What is Pernicious anemia?
  • Pernicious anemia is one of the rare diseases under the age of 30. The most important cause of the disease is the parietal cell antibodies (84%). The second most common reason is anti-IF antibodies (56%). Due to these antibodies, atrophy develops in the parietal cells of the stomach. Oral vitamin B12 cannot be absorbed and excreted.
  • What are the methods of diagnosis of pernicious anemia?
  • As the Parietal cell antibodies are found in healthy people, a specific diagnostic value for the diagnosis of pernicious anemia cannot be found. There is no correlation between vitamin B12 level and neurological findings. Anemia (low hemoglobin in the blood) and neurological findings are specific findings for vitamin B12 deficiency. The tongue is large, sore, and red, and at this stage it is called " Hunter language " or the " beef tongue ". Subicter (jaundice) may occur in B12 deficiency. All kinds of neurological findings can be seen in B12 deficiency. In B12 deficiency, there may be mental disorders such as deep sensory loss, taste, smell, visual disturbances, irritability, depression, paranoia, hallucination, delusion, mania, and panic (neurological findings are not correlated with the severity of anemia and sometimes even inversely related to the correlation). If the suspicion of vitamin B12 deficiency is strong and serum vitamin B12 levels are borderline low, the level of methyl malonic acid in the urine may be helpful. Intrinsic factor antibody, parietal cell antibody, may not always support the diagnosis. Anti-parietal cell antibodies are present in 90% of patients with pernicious anemia (5% of the healthy population) and 60-70% of intrinsic factor antibodies (rare in the healthy population). Serum gastrin levels are typically elevated in laboratory findings; hemoglobin, leukocytes, and platelets are low. For diagnostic purposes, vitamin B12 values below 200 pg / ml are considered to be low. Vitamin B12 level may be false low during pregnancy and in those using OCS. It may be false high in myeloproliferative diseases.


  • What are the treatment methods for vitamin B12 deficiency?
  • As treatment, B12 (cyanocobalamin or hydroxocobalamin) is administered as IM every 5 days in the first week, then 1000 micrograms / week (3 weeks) then 1000 microg / month. Treatment is lifelong in pernicious anemia. In response to the treatment, the first recovery is the bone marrow, within 24-48 hours the bone marrow returns to normal. Increase in hematocrit values ​​starts on the 10th day. The last finding to improve is neurological findings. Improvement can be found between the 12th -18th month. Sometimes there may not be complete recovery.


  • What should we consume to overcome vitamin B12 deficiency?
  • Liver, spleen, shellfish, milk, yogurt, cheese, eggs are among the foods which is rich in B12. It is recommended that people with B12 deficiency consume these products.



Spec. Dr. Günel BAYRAMOVA

Internal Diseases