Symptoms of Vitamin B12 Deficiency

 

The initial symptoms of vitamin B12 deficiency are insidious and could easily be overlooked. The classical symptoms of anaemia are by no means obligatory. Early symptoms/findings of anaemia may also be masked by excess folic acid, or concurrent iron deficiency. Diffuse neuropsychiatric symptoms may often be the earliest symptoms.

 

The commonest neurological symptoms in vitamin B12-deficiency are paraesthesia of the hands and feet, diminished perception of vibration and position, absence of reflexes, and unsteady gait and balance (ataxia), but the range of symptoms is broad.

 

The psychiatric symptoms associated with vitamin B12 deficiency are also varied and fall into several different clinical categories. Confusion and memory disturbances are the most common. Depression, with or without psychotic components, and cognitive decline are frequent. Swings in mood and personality changes may be early signs of what may later be manifested as psychiatric disease. Such vague symptoms of vitamin B12 deficiency are easily overlooked, especially as the serum concentration of vitamin B12 can lie within the reference range.

 

Many disorders in the gastrointestinal tract can give rise to a deficiency of vitamin B12. Symptoms from the gastrointestinal tract, more or less pronounced, may be present, as well as poor mucosal function with subsequent specific symptoms such as glossitis.

 

Elderly persons are especially at risk of developing a vitamin B12 deficiency. Age-related, often asymptomatic atrophic gastritis is common and may be enough to cause a patient to slide slowly into a negative vitamin B12 balance with depleted stores of the vitamin, giving rise to vitamin B12 deficiency.

 

Infants of vegetarian/vegan mothers are also in danger of developing vitamin B12 deficiency, even though their mothers may not suffer from disorders of B12 absorption and do not show any deficiency symptoms. This is due to the relatively high requirement in the rapidly growing child.

 

Vitamin B12-deficiency concomitant with auto-immune diseases other than pernicious anaemia is often seen (eg. thyroid disease).

 

At risk groups

Patients at risk for B12 deficiency should raise the index of suspicion. These include the elderly, vegetarians and vegans, patients with intestinal disease and after surgery to stomach. Other groups include those with autoimmune thyroid disorders, hypothyroidism, patients on long term therapy with protein pump inhibitors and histamine receptor antagonists (particularly the elderly) and patients using biguanides for glycemic control.

 

Symptoms/conditions where vitamin B12 deficiency could be suspected.

  • Neurological symptoms:

Numbness in hands and feet

Ataxia

Impaired reflexes

Gait disturbances

Impaired vibration perception

Positive Romberg´s test

Babinsky´s sign

Lhermitte´s sign

Optic atrophy

  • Psychiatric symptoms:

Concentration difficulties

Confusion

Irritation

Impaired memory

Dementia

Irritability

Depression

Personality changes

Psychosis

  • Chronic fatigue syndrome/fibromyalgia
  • Symptoms of anaemia:

Tiredness

Apathy

Effort dyspnoea

  • Other symptoms

Aversion to meat

Impotence

Faecal/urinary incontinence

Infertility

 

  • Patients complaining of:

Vertigo

Asthenia

Loss of appetite

Loss of weight

Impaired memory

  • After resection of the stomach or ileum
  • Gastrointestinal disease:

Atrophy of the mucosa

Gluten-induced enteropathy

Crohn´s disease

  • Inadequate nutrition
  • Smoking
  • High alcohol consumption
  • Vegans/vegetarians
  • Autoimmune diseases:

Diabetes

Rheumatoid arthritis

Hypothyroidism

  • Previous pregnancy complications
  • Anaesthesia with nitrous oxide
  • Medication with drugs affecting B12
  • Vitiligo
  • Hair loss
  • Marfanoid appearance
  • Adverse reactions to anaesthesia / surgery

 

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ACTIVE-B12 LICENSED TO SIEMENS HEALTHCARE

Axis-Shield will develop the Active-B12 test for Siemens Healthcare allowing more laboratories worldwide to perform the test.

B12 LEVELS FALSELY ELEVATED IN PERNICIOUS ANAEMIA

A new publication has demonstrated that five different Total B12 assays gave normal B12 results in a patient with confirmed pernicious anaemia. To access the paper click here.

EXPERTS AGREEMENT ON UTILITY OF ACTIVE-B12

An experts meeting at a recent conference produced a Consensus Statement on the improved utility of the Active-B12 assay over Total B12. To see the statement click here.

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