Vitamin B12 deficiency is common. This presentation covers epidemiology, signs and symptoms, diagnosis and treatment strategies of vitamin B12 deficiency.

1. VITAMIN B12 IN HEALTH AND
DISEASE
DR SUDHIR KUMAR MD (MED) DM (NEURO), SENIORCONSULTANT
NEUROLOGIST
APOLLO HOSPITALS, HYDERABAD

2. WHAT MY TALK WOULD COVER?
 Prevalence of vitamin B12 deficiency
 Who are at risk of developing vitamin B12
deficiency?
 Signs and symptoms of vitamin B12
deficiency
 Diagnosis of vitamin B12 deficiency
 Treatment- which form of B12 is better?
 Oral versus injection of vitamin B12

3. PREVALENCE OF VITAMIN B12 DEFICIENCY
 In asymptomatic people, 33% have vitamin
B12 deficiency (J Clin Diag Research, 2015)
 Among vegetarians (47%) and non-
vegetarians (20%)
 In another study (NIN, Hyderabad), the
prevalence among apparently healthy urban
adults was found to be 35% (Ann Nutr Metab, 2016)
 54% among vegetarians and 31% among non-
vegetarians

4. PREVALENCE OF B12 DEFICIENCY (2)
 Among adolescents (10-18 yrs) with anemia,
50% have vitamin B12 deficiency (Indian Pediatrics,
2015)
 Prevalence increases among elderly, due to
lesser B12 absorption, and atrophic gastritis.
 Among pregnant women, 75% had low
vitamin B12 levels <200 (AIIMS, 2007, Food Nutr Bull)
 In another study, 51% of women in early
pregnancy had low B12 levels <150 (Ann Nutr Metab,
2013)

5. WHO ARE AT RISK OF B12 DEFICIENCY?
 Vegetarians
 Pernicious anemia, due to poor absorption (anti
IF, anti parietal cell antibodies)
 Malabsorption, after surgical resection of ileum
 Adolescents
 Older people,
 Pregnant women,
 Medications- omeprozole, ranitidine, metformin

6. CLINICAL FEATURES
 Anemia
 Neurological disorders
 Psychiatric disorders
 Skin features
 Coronary artery disease

7. CLINICAL FEATURES (2)
ANEMIA
 Megaloblastic anemia
 High MCV- macrocytosis
 Hypersegmented neutrophils
 In some people with B12 deficiency, Hb and
MCV may be normal
 Bone marrow exam shows megakaryocytes

8. CLINICAL FEATURES (3)
NEUROLOGICAL FEATURES (Aaron S, Sudhir Kumar, et al,
Neurology India, 2005)
 Myelo-neuropathy
 Cognitive impairment, dementia
 Peripheral neuropathy
 Recurrent seizures (Sudhir Kumar, Neurology India, 2004)
 Extrapyramidal syndrome (Sudhir Kumar, Neurology India,
2004)

9. CLINICAL FEATURES (4)
Psychiatric features
 Depression
 Psychosis
 Acute mania

10. CLINICAL FEATURES (5)
Skin manifestations
 Hyperpigmentation of knuckles
 Hyperpigmentation of oral mucosa

11. CLINICAL FEATURES (6)
 Coronary artery disease
 High triglyceride levels
 Pregnancy complications, birth defects and
abortions
 Lesser immunity

12. DIAGNOSIS OF B12 DEFICIENCY
 Serum vitamin B12 level: less than 200 pg.ml
is suggestive of deficiency
 Symptoms may start at 500-600 pg/ml levels
also
 High serum homocysteine levels
 Peripheral blood picture, CBP
 High LDH, low retic count
 Bone marrow examination

13. DIAGNOSIS (2)
 Nerve conduction studies
 MRI of brain and spine

14. TREATMENT OF B12 DEFICIENCY
 Vitamin B12 supplementation
 Methylcobalamin, hydroxycobalamin or
cyanocobalamin forms
 Initially injection, then oral tablets
 High dose vitamin B12 supplementation-
1500 mcg per day)
 Needs to be continued for months to years

15. PROGNOSIS
 Majority of people improve after treatment
 Partial or complete recovery is common
 If untreated, severe complications occur
 Neurological damage may be irreversible
 Vitamin B12 treatment is usually not
associated with side effects or toxicity

16. CONCLUSIONS
 Vitamin B12 deficiency is common among
general public and patients coming to
hospitals
 Symptoms are varied and affect multiple
systems
 Diagnosis can be made on the basis of clinical
features and simple investigations
 Treatment can be done with oral of injectable
forms of B12
 Prognosis is good

18. ANY QUERIES??
THANKS
drsudhirkumar@yahoo.com
9866193953
http://bestneurodoctor.blogspot.in/
http://www.facebook.com/bestneurologist/