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B12 deficiency care

From Dr RB Dawood

Pinner, Middlesex

Further to your item on vitamin B12 deficiency (News, 13 April), one of the commonest causes in the UK is the vegetarian diet of the Asian Gujarati community.

If I find B12 deficiency I never administer an injection of hydroxocobalamine to start with unless the deficiency is extremely severe and the patient has symptoms.

Instead I will give oral cyanocobalamin (50mg-100mg daily) and repeat the blood test in two-three months.

If the B12 level is corrected there is no need for any unnecessary investigations because this proves the problem is dietary in origin. Such patients are given the choice of daily oral therapy or injections four times a year.

If there is no improvement after excluding compliance problems, then investigations such as parietal cell and/or intrinsic factor antibodies, Schillings test, endoscopy and barium studies are necessary.

These should also be considered in non-vegetarians after a good diet history.

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