B12 deficiency causing nerve issues

I was referred to see a neurologist due to B12 deficiency causing nerve issues (pins and needles and numbness). this neuro has confirmed I do have some damage, but does not feel I need further B12 that 1 injection every 3 months, which is my current schedule. My symptoms go when I get the jab, then return after about 6-7 weeks. This is contrary to everything I have read. Therefore, I feel I need more and they should treat my symptoms in accordance with the NICE Guidelines. How do I see someone who knows about B12d and doesn't just tell me to 'eat more spinach' which FYI contains no B12 anyway, even if I was absorbing orally...

18 October 2016

The treatment regime of vitamin B12 deficiency is dependent to the cause – and in the original question, the cause of the deficiency is not disclosed. The most common cause is pernicious anaemia, where vitamin B12 cannot be absorbed by the body and in turn, affects the capacity of our red blood cells to carry oxygen efficiently. More uncommon causes are stomach issues, certain medicines and dietary insufficiency (the latter being unusual in those undertaking a balanced diet).

The prescribing schedule considered for a person with pernicious anaemia with neurological involvement i.e. pins and needles and numbness, is initially an intramuscular injection of 1mg hydroxocobalamin (vitamin B12) once daily on alternate days and then 1mg injection every two months. However, if pernicious anaemia presents with no neurological involvement, then the schedule is different with a regime of 1mg injection every three months.

There is a small group of patients who reports symptoms returning earlier than the next scheduled injection. These patients may have injections more frequently or need to re-discuss with their doctor.

If for example, a patient with diagnosed pernicious anaemia with neurological involvement is having injections every two months but reports recurring symptoms prior to their next injection, specialist advice from a haematologist should be sought.

Relating back to the original question here, the exact cause of the deficiency needs to be clarified. If it is attributed to pernicious anaemia then the schedule of three-monthly injections may not be the most appropriate and the interval should be shortened to two-monthly as per BNF guidance. Likewise, the break-through in symptoms for the above pernicious anaemia with neuro involvement patient should be managed with the inclusion of haematologist advice as per NICE guidance. Touching on the topic of diet, fruit and vegetables do not contain vitamin B12 but rich sources include meat, fish, eggs and milk.

We hope that this has been helpful.

Answered by the Health at Hand nurses  

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