How I treat cobalamin (vitamin B12) deficiency
Open Access
- 15 September 2008
- journal article
- Published by American Society of Hematology in Blood
- Vol. 112 (6), 2214-2221
- https://doi.org/10.1182/blood-2008-03-040253
Abstract
The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor–driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose. The virtues of these principles are not always fully appreciated. Recent developments have made diagnosis and management more difficult by diminishing the ability to determine cobalamin absorption status. Clinicians must also grapple with premature medicalization of isolated, mild biochemical changes that added many asymptomatic cases of still undetermined medical relevance to their caseload, often expanded by inflated cobalamin level criteria. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. Pathophysiologically based management requires systematic attention to each of its individual components: correctly diagnosing cobalamin deficiency, reversing it, defining its underlying cause, preventing relapse, managing the underlying disorder and its complications, and educating the patient.This publication has 77 references indexed in Scilit:
- Allergy to vitamin B12: two cases of successful desensitization with cyanocobalaminAllergy, 2007
- Helicobacter pylori Infection, Vitamin B12 and HomocysteineDigestive Diseases, 2003
- Current Concepts in Cobalamin DeficiencyAnnual Review of Medicine, 2000
- Vitamin B12 and folic acid deficiency in chronic pancreatitis: a relevant disorder?Journal of Molecular Medicine, 1991
- Cobalamin and unsaturated transcobalamin values in pernicious anaemia: Relation to treatmentScandinavian Journal of Haematology, 1986
- Is nitrous oxide a dangerous anesthetic for vitamin B12-deficient subjects?JAMA, 1986
- Relapses after interruption of cyanocobalamin therapy in patients with pernicious anemiaThe American Journal of Medicine, 1983
- Cobalamin Forms in Plasma and Tissue during Treatment of Vitamin B12 DeficiencyScandinavian Journal of Haematology, 1982
- Clinically significant vitamin B12 deficiency secondary to malabsorption of protein-bound vitamin B12Digestive Diseases and Sciences, 1979
- ORAL TREATMENT OF PERNICIOUS ANEMIA WITH HIGH DOSES OF VITAMIN B12 WITHOUT INTRINSIC FACTORActa Medica Scandinavica, 1968