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. There are 2 types of vitamin B12 injections: Hydroxocobalamin is usually the recommended option as it stays in the body for longer. 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. The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which is not related to your diet. If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take 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. Although it's less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved. Good sources of vitamin B12 include: If you're a vegetarian or vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract (including Marmite), as well as some fortified breakfast cereals and soy products. Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain. 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. Your haematologist will advise on how long you need to keep taking the injections. For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer. If you need regular injections of vitamin B12, cyanocobalamin would need to be given once a month, whereas hydroxocobalamin can be given every 3 months. Cyanocobalamin injections are not routinely available on the NHS as hydroxocobalamin is the preferred treatment. But if you need replacement tablets of vitamin B12, these will usually be in the form of cyanocobalamin. 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. Good sources of folate include:
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. 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. To ensure your treatment is working, you may need to have further blood tests. A blood test is often carried out around 10 to 14 days after starting treatment to assess whether treatment is working. This is to check your haemoglobin level and the number of the immature red blood cells (reticulocytes) in your blood. Another blood test may also be carried out after approximately 8 weeks to confirm your treatment has been successful. If you have been taking folic acid tablets, you may be tested again once the treatment has finished (usually after 4 months). Most people who have had a vitamin B12 or folate deficiency will not need further monitoring unless their symptoms return or their treatment is ineffective. If your GP feels it's necessary, you may have to return for an annual blood test to see whether your condition has returned.
Page last reviewed: 23 May 2019 Medically Reviewed by Carol DerSarkissian, MD on May 10, 2021 When your body can’t make enough healthy red blood cells because it lacks vitamin B-12, you have pernicious anemia (PA). A long time ago, this disorder was believed to be fatal (“pernicious” means deadly). These days it’s easily treated with B-12 pills or shots. With treatment, you’ll be able to live without symptoms. Your body needs plenty of healthy red blood cells. These are what carry oxygen to every part of your body. Without them, your tissues and organs don’t work like they should. Vitamin B-12 is a crucial part of this process. If your body doesn’t absorb enough from the food you eat, your red blood cells will be too big to travel well through your body. Because of this, your body will make less of them. And the cells that are made will die off sooner than they should. The reason this happens is often due to the lack of a stomach protein called “intrinsic factor” (IF). Your body can’t absorb vitamin B-12 without it. Some health issues make you more likely to have PA. These include: Some medicines, like antacids or drugs that treat type 2 diabetes, can make it harder for your body to absorb enough B-12. A strict vegetarian diet puts you at risk for PA too, since you won’t be eating foods that are rich in B-12 like eggs, milk, and poultry. Also, if someone else in your family has PA, your risk of having it goes up as well. PA affects people in different ways. These can be signs you have it: Your doctor will ask about your family history. They’ll want to know your symptoms, plus what types of food you often eat and any medicines you take every day. During a physical exam, your doctor will listen to your heart, check to see if your liver’s enlarged, and look for any signs of nerve damage. They may do tests that check your balance, how well you can walk, and your mental status. Your doctor will also order blood work. This can reveal if you have a low amount of hemoglobin. That’s the substance in red blood cells that helps carry oxygen throughout your body. It can check to see the size and shape of your red blood cells. It can also tell the amount of B-12 in your blood that’s “active,” and ready for your body to use. Vitamins you buy at the drug store don’t have enough B-12 in them to treat PA. Your doctor will need to prescribe a special supplement to you. This is often given in a shot. At first, you may need to have one every other day. Over time, you may be able to cut back to once a month. Extra B-12 can also be prescribed as a pill, nose spray, nasal gel, or medicine you put under your tongue. Your doctor will likely also suggest some changes to your diet. Eating more foods that are high in vitamin B-12 can help you feel better, too. © 2021 WebMD, LLC. All rights reserved. View privacy policy and trust infoAuthor Srikanth Nagalla, MD, MS, FACP Chief of Benign Hematology, Miami Cancer Institute, Baptist Health South Florida; Clinical Professor of Medicine, Florida International University, Herbert Wertheim College of Medicine Srikanth Nagalla, MD, MS, FACP is a member of the following medical societies: American Society of Hematology, Association of Specialty Professors Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Alexion; Alnylam; Kedrion; Sanofi; Dova; Apellis; Pharmacosmos<br/>Serve(d) as a speaker or a member of a speakers bureau for: Sobi; Sanofi; Rigel. Coauthor(s) Salem Kim, MD, MPH Physician in Hematology/Oncology, Miami Cancer Institute, Baptist Health South Florida Salem Kim, MD, MPH is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology Disclosure: Nothing to disclose. Chief Editor Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences Disclosure: Nothing to disclose. Additional Contributors Marcel E Conrad, MD Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, SWOG Disclosure: Partner received none from No financial interests for none. Paul Schick, MD † Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology Disclosure: Nothing to disclose. Acknowledgements David Aboulafia, MD Medical Director, Bailey-Boushay House, Clinical Professor, Department of Medicine, Division of Hematology, Attending Physician, Section of Hematology/Oncology, Virginia Mason Clinic; Investigator, Virginia Mason Community Clinic Oncology Program/SWOG David Aboulafia, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Directors Association, American Society of Hematology, Infectious Diseases Society of America, and Phi Beta Kappa Disclosure: Nothing to disclose. Troy H Guthrie, Jr, MD Director of Cancer Institute, Baptist Medical Center Troy H Guthrie, Jr, MD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society of Hematology, Florida Medical Association, Medical Association of Georgia, and Southern Medical Association Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment |
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