Vitamin B12 deficiency in over 16s: diagnosis and management - guidance (NG239)
New guideline covers recognising, diagnosing and managing vitamin B12 deficiency in people aged 16 and over, including deficiency caused by autoimmune gastritis. It also covers monitoring for gastric cancer in people with autoimmune gastritis.
Source:
National Institute for Health and Care Excellence
SPS commentary:
A 2-page visual summary is available on ongoing care and follow-up options for oral and intramuscular vitamin B12 replacement.
Following oral vitamin B12 replacement, if symptoms have improved or resolved (no longer interfering with normal daily life), treatment may be stopped if the cause/suspected cause of deficiency has been addressed. If the cause has not been addressed or is unknown, continued oral replacement is recommended with further follow up. For new or worsening symptoms, alternative diagnoses and dose escalation or switching to intramuscular vitamin B12 injection should be considered. For symptoms that are not sufficiently improved (still interfering with normal daily life), dose escalation or switching to intramuscular vitamin B12 injection is advised.
Following intramuscular vitamin B12 replacement, for symptoms that are improved or resolved, continued use of injections is recommended (lifelong if the cause of deficiency is or is suspected to be irreversible). If the cause of deficiency is resolved, the prescriber should think about stopping or reducing frequency of injections. For symptoms are new, worsening or not sufficiently improved, the guidance advises to increase the frequency of injections if needed in line with manufacturer’s product information.