If you have low vitamin B12 level for a long time, you can have nerve damage. Symptoms of nerve damage include:
Confusion or change in mental status (dementia) in severe cases
Loss of balance
Numbness and tingling of hands and feet
Exams and Tests
The doctor or nurse will perform a physical exam. This may reveal problems with your reflexes.
Tests that may be done include:
Complete blood count (CBC)
Vitamin B12 level
Other procedures that may be done include:
Esophagogastroduodenoscopy (EGD) to examine the stomach
Enteroscopy to examine the small intestine
Bone marrow biopsy if the diagnosis is not clear
Treatment depends on the cause of B12 deficiency anemia.
The goal of treatment is to increase your vitamin B12 level.
Treatment may include a shot of vitamin B12 once a month. Persons with a severely low level of B12 may need more shots in the beginning. You may need shots every month for the rest of your life.
Some patients may also need to take vitamin B12 supplements by mouth. For some people, high-dose vitamin B12 tablets taken by mouth work well, and shots are not needed.
Treatment may no longer be needed after Crohn disease, celiac disease, or alcoholism is properly treated.
Your doctor or nurse will also recommend eating a well-balanced diet.
Patients often do well with treatment.
Long-term vitamin B12 deficiency can cause nerve damage. This may be permanent if you do not start treatment within 6 months of when your symptoms begin.
A woman with a low B12 level may have a false positive Pap smear. This is because vitamin B12 deficiency affects the way certain cells (epithelial cells) in the cervix look.
When to Contact a Medical Professional
Call your health care provider if you have any of the symptoms of anemia.
You can prevent anemia caused by a lack of vitamin B12 by following a well-balanced diet.
Shots of vitamin B12 can prevent anemia after surgeries known to cause vitamin B12 deficiency.
Early diagnosis and prompt treatment can reduce or prevent complications related to a low vitamin B12 level.
Antony AC. Megaloblastic anemias. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 37.
Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.