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Vitamin B12 and Folate (B9) Deficiency

NICE guideline [NG239] Vitamin B12 deficiency in over 16s: diagnosis and management. Published: Mar 2024.

NICE CKS Anaemia – B12 and folate deficiency. Last revised: Mar 2024.

Vitamin B12 and folate deficiencies are grouped together in this article due to overlapping features, with important distinctions outlined

Background Information

Pathophysiology

Vitamin B12 Deficiency

Vitamin B12 (cobalamin) acts as a co-factor to 2 enzymatic reactions: [Ref]

Enzyme Reaction Consequence in deficiency
Methionine synthase Homocysteine → methionine Defective DNA synthesis and methylation → megaloblastic anaemia (dys-synchrony between the maturation of cytoplasm and the nuclei)
Methylmalonyl-CoA mutase Methylmalonyl-CoA → succinyl-CoA Accumulation of methylmalonic acid and abnormal fatty acid metabolism → disrupted myelin synthesis → neurological deficits

Folate (B9) Deficiency

Folate deficiency primarily impairs DNA synthesis, resulting in:

  • Megaloblastic anaemia
  • Neurological involvement is RARE and not characteristic (mainly seen in B12 deficiency)

Folate acts as a co-factor for:

  • DNA synthesis (purine and thymidylate synthesis)
  • Methylation reactions (including homocysteine to methionine)
  • Amino acid metabolism

Aetiology

Vitamin B12 Deficiency

Most common cause: pernicious anaemia (autoimmune gastritis)

  • Autoimmune destruction of gastric parietal cells (which normally secrete intrinsic factor)
  • → Lack of intrinsic factor → impaired vitamin B12 absorption at the terminal ileum

Absorption of vitamin B12:

  1. Vitamin B12 binds to haptocorrin (produced by the salivary gland), which protects it from gastric acid
  2. In the duodenum, vitamin B12 binds to intrinsic factor (produced by gastric parietal cells)
  3. Vitamin B12-intrinsic factor complex is absorbed in the terminal ileum

Importantly, vitamin B12 can only be absorbed in the terminal ileum, if it is bound to intrinsic factor.

Other causes are rare:

Nutritional
  • Malnutrition
  • Vegan diet
Drugs
  • Nitrous oxide (usually from recreational use)
  • Metformin
  • PPIs, H2 receptor antagonists (gastric acid is necessary to release B12 from food protein)
  • Colchicine
Malabsorption
  • Coeliac disease
  • Ileal disease (e.g. Crohn’s disease)
  • Pass GI surgeries
    • Gastrectomy
    • Bariatric operations (e.g. Roux-en-Y gastric bypass / sleeve gastrectomy)
  • Zollinger-Ellison syndrome
  • Parasites (e.g. giardiasis, fish tapeworm)

Folate (B9) Deficiency

Nutritional
  • Alcoholism
  • Poor diet
Malabsorption
  • Coeliac disease – leading cause
  • Jejunal resection (folate is absorbed in the jejunum)
  • Inflammatory bowel disease
  • Tropical sprue
Drugs
  • Anti-folate agents
    • Trimethoprim
    • Methotrexate
  • Anticonvulsants (e.g. phenytoin)
  • Nitrofurantoin
  • Sulfasalazine
Increased requirements
  • Pregnancy and lactation
  • Malignancy (e.g. leukaemia, lymphoma, carcinoma)
  • Blood disorders (e.g. sickle cell anaemia, haemolytic anaemias, myelofibrosis)
  • Inflammatory diseases (e.g. tuberculosis, Crohn’s disease, malaria)

Clinical Features

Note that vitamin B12 deficiency can present without anemia, where the clinical manifestations may primarily be dermatological and neuropsychiatric.

Clinical features of folate deficiency are largely similar to those of B12 deficiency, except that neurological involvement is RARE and not characteristic of folate deficiency.

Haematological features (anaemia) Symptoms:
  • Fatigue
  • Exertional dyspnoea
  • Weakness
  • Tiredness
  • Reduced exercise tolerance and chest pain (mainly seen in severe anaemia)

Signs:

  • Conjunctival pallor
  • Cold skin
  • Tachycardia, tachypnoea
  • Systolic flow murmur (due to hyperdynamic state)
Dermatological features
  • Lemon tinge to the skin (from the mix of pallor and mild jaundice)
  • Atrophic glossitis (smooth, glossy, erythematous tongue due to loss of papillae)
  • Pallor of the mucous membranes / nail beds
  • Brown pigmentation of the nail beds and skin creases (but not mucous membranes)
Neurological features
  • Symmetrical peripheral neuropathy (lower limb >> upper limb) 
    • Distal paraesthesia and numbness
    • Absent ankle reflex
  • Subacute combined degeneration of the cord (demyelination of the dorsal and lateral columns of the spinal cord)
    • Loss of vibration and proprioception sensation
    • Sensory ataxia and gait instability (+ve Romberg sign)
    • Spastic paraparesis (Babinski sign, hypertonia, spasticity)
    • Bladder and bowel dysfunction in advanced cases
  • Optic neuropathy (bilateral) (e.g. central scotoma, visual disturbances)
Psychiatric features
  • Cognitive impairment (e.g. difficulty concentration, short-term memory loss, ‘brain fog’
  • Dementia
  • Delirium
  • Depression
  • Psychosis

Vitamin B12 classically cause a mix of upper and lower motor neuron signs, due to concurrent involvement of the spinal cord and peripheral nerves

  • Spinal cord involvement (subacute combined degeneration of the cord) → upper motor neuron signs (e.g. spasticity, hypertonia, Babinski sign)
  • Peripheral nerve involvement → lower motor neuron signs (e.g. symmetrical distal paraesthesia, absent ankle reflex)

Diagnosis

Confirming Deficiency

Perform the following initial tests, if vitamin B12 or folate deficiency is suspected:

Test Findings in B12 / folate deficiency
FBC Macrocytic anaemia
  • ↓ Hb
  • ↑ Mean corpuscular volume (MCV)
  • ↑ Mean corpuscular haemoglobin
Peripheral blood smear Hypersegmented neutrophils
  • >5% of neutrophils with at least 5 lobes, or
  • At least 1 neutrophils with at least 6 lobes

Presence of hypersegmented neutrophils confirms megaloblastic anaemia, which helps differentiate from causes of macrocytic, non-megaloblastic anaemia (e.g. alcohol use, liver disease).

Serum cobalamin (B12) test ↓ (in B12 deficiency)

Choice of test:

  • Most patients: total B12 (cobalamin) or active B12 (holotranscobalamin)
  • During pregnancy → active B12 (holotranscobalamin)
  • Recreational nitrous oxide use is suspected as the cause → measure serum homocysteine or methylmalonic acid level (over serum B12) 

 

The following factors may affect the interpretation of total or active B12 test result:

  • If patient already taking some form of vitamin B12 → may increase the B12 levels without fully treating the deficiency
  • If patient takes COCP → may lower total B12 levels without causing a deficiency
Folate levels ↓ (in folate deficiency)

If the serum B12 tests are inconclusive / equivocal, and B12 deficiency is suspected → consider measuring the serum methylmalonic acid levels.

Measuring serum homocysteine and methylmalonic acid levels can help distinguish between B12 and folate deficiency. [Ref]

↑ Methylmalonic acid is specific for B12 deficiency, such that: [Ref]

  • B12 deficiency causes ↑ homocysteine and ↑ methylmalonic acid levels
  • Folate deficiency only causes ↑ homocysteine level

Investigating Underlying Cause

Key clinical history to ask for:

  • Dietary history
  • Medication review

Vitamin B12 Deficiency

1st line: testing for pernicious anaemia (autoimmune gastritis)

  • Initial test of choice: anti-intrinsic factor antibody test
  • 2nd line tests (if anti-intrinsic factor antibody is -ve but pernicious anaemia still suspected)
    • Anti-gastric parietal cell antibody
    • Gastrin levels
    • CobaSorb test
    • Gastroscopy with gastric body biopsy (specialist test)

 

2nd line: coeliac testing

  • Initial test of choice: IgA tTG + total IgA (see the Coeliac Disease article for more information)
  • NICE: “Offer serological testing for coeliac disease where the cause of vitamin B12 deficiency is still unknown after further investigations”

Rationale of why coeliac testing is a 2nd line test: B12 deficiency is the least common deficiency (compared to iron and folate) in coeliac disease, as coeliac disease primarily affects the duodenum and jejunum.

Folate (B9) Deficiency

1st line: coeliac testing

  • Initial test of choice: IgA tTG + total IgA (see the Coeliac Disease article for more information)

Rationale: coeliac disease is the main cause of folate malabsorption.

Management

Do NOT delay vitamin B12 replacement while waiting for the test results of people with suspected megaloblastic anaemia and neurological symptoms.

Vitamin B12 Deficiency

First step to guide management is whether there is neurological involvement or not.

Neurological Involvement

Seek urgent specialist advice (neurologist / haematologist)

If specialist management not immediately available, consider IM vitamin B12 (hydroxocobalamin)

  • Loading phase: once on alternate days until no further improvement
  • Maintenance phase: once every 2 months

NO Neurological Involvement

Management depends on the suspected underlying cause:

Underlying cause Management
Malabsorption Lifelong IM vitamin B12 is necessary in :
  • Pernicious anaemia (autoimmune gastritis)
  • Patients with total gastrectomy
  • Patients with complete terminal ileal resection

For other causes of malabsorption (e.g. coeliac disease, Crohn’s disease, partial gastrectomy) → IM vitamin B12 should be considered over oral.

Medication
  • Review if the causative medication can be changed to an alternative, or is needed
  • Offer oral or IM vitamin B12 replacement (based on person’s preference)
Recreational NO
  • Advise the person to stop using NO recreationally
  • Offer oral or IM vitamin B12 replacement (based on person’s preference)
Dietary
  • Optimise dietary intake
  • 1st line: oral vitamin B12 replacement
  • 2nd line: IM (if there are concerns to adherence – e.g. multimorbidity, frailty, delirium, cognitive impairment)
Unknown cause
  • Consider oral vitamin B12 replacement (over IM) and review response to treatment

Different forms of vitamin B12:

  • IM: hydroxocobalamin
  • Oral: cyanocobalamin

Folate (B9) Deficiency

Offer oral folic acid (5mg daily)

  • Most patients would require treatment for 4 months
  • Some patients may need to take folic acid for longer, or even for life

It is important to note that when BOTH B12 and folate deficiencies are co-present, it is important to correct B12 deficiency FIRST, before correcting folate deficiency. [Ref]

Rationale: folic acid is harmful in B12 deficiency. If folate deficiency is corrected first, it may worsen neurological complications, or allow them to progress by masking symptoms (as folic acid can improve anaemia in B12 deficiency, but it will NOT correct the neurological damage). [Ref]

References

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