Vitamin B12 Deficiency

Have you been lately suffering from rapid heartbeats, tiredness, pale skin and constipation? You might be having suffering from a deficiency of Vitamin B12. Read and know all about the disorder, including its possible causes, symptoms, treatment, complications and prognosis.

What is Vitamin B12 Deficiency?

As the name indicates, it is a condition characterized by a lack of the water soluble vitamin known as B12. A deficiency of this vitamin, which is vital for physical processes, increases the risk of heart attack and can damage the nerve cells apart from giving rise to a host of other problems.

The disorder is also referred to as Hypocobalaminemia.

What is Vitamin B12?

Also referred to as Cobalamin, it is an important vitamin that is necessary for a number of vital functions of the body. Along with the B vitamin folate, it helps create the genetic material of the human body. It helps maintain the levels of the amino acid known as homocysteine – which is supposed to reduce the risk of heart attacks. It is also important for the manufacture of red blood cells or RBCs which transport oxygen to various tissues of the body through blood.

Vitamin B12 Deficiency ICD9 Code

The ICD9 Code for this disorder is 266.2.

Vitamin B12 Deficiency Incidence

The exact incidence of the condition is not known. However, it is estimated to affect anywhere between 300,000 to 3 million people in the United States. According to certain studies, the disorder has a 3-40% incidence in the general population.

Vitamin B12 Deficiency Causes

The condition can arise due to a number of factors:

Impaired digestive systems

It typically arises in individuals who have defective digestive systems that fail to properly absorb the B12 vitamin from the foods that they consume. The vitamin, before being utilized, must be processed inside the stomach. It must also be absorbed inside the small intestine to enter the bloodstream. If the stomach fails to produce adequate amounts of the necessary enzymes or acids, or if the small intestine fails to absorb the vitamin, a deficiency can arise as a result.

AIDS and other disorders

Disorders of the small intestine like Crohn’s disease or surgical removal of a part of the small intestine can lead to too little absorption of the B12 vitamin. People suffering from AIDS may also have trouble in absorbing this nutrient.

Side effects of certain medications

Some medicines may also interfere with the absorption of the B12 vitamin. These include medications like:

  • Colchicine, used for curing gout
  • Phenytoin, used to cure seizures
  • Metformin, for the treatment of diabetes
  • Acid-reducing drugs, that are used to cure ulcers

Those suffering from low levels of Vitamin B12 and using any of the above drugs should consult their doctors and seek some alternative medicines.

Low dietary intake of Vitamin B12

As the vitamin can mainly be found in animal products, vegetarians can also suffer from a deficiency of this vital component. Those who are strict vegetarians and do not consume any animal products such as eggs, meat or even milk, are the most susceptible to this condition.

Even those vegans who consume milk products and eggs are at risk of suffering from the condition as they tend to consume lower than half of the recommended amount of the B12 vitamin.

Being born to B12-deficient mothers

Babies, who are born to mothers deficient in this vitamin, also suffer from this condition.

Excessive alcohol consumption

Excessive consumption of alcohol can also hamper proper absorption of the vitamin.

Vitamin B12 Deficiency Risk Factors

The risk factors for this disease include:

Being of a certain age

The condition can affect people of any age group. However, it is found to arise more frequently in individuals aged between 40 and 70 years of age.

Being women

Pernicious anemia (PA), a natural consequence of this disorder, affects males and females equally in the United States. However, it is more prevalent in older females than males in Europe and Africa.

Being Hispanic

The prevalence of PA is higher in white population and may be reduced in black individuals and those of Hispanic origin.

Vitamin B12 Deficiency Symptoms

The condition gives rise to a host of problems in sufferers. A lack of B12 can cause Vitamin B12 Deficiency anemia. A moderate lack of the vitamin may only give rise to mild symptoms. However, as the anemia worsens, patients may experience more acute problems such as:

  • Sore tongue
  • Pale skin
  • Rapid breathing
  • Fast heartbeat
  • Tiredness or fatigue
  • Lightheadedness
  • Constipation or diarrhea
  • Weight loss
  • Stomach upset
  • Tendency to bleed or bruise easily, including bleeding from gums

Unless the deficiency is treated on time, the nerve cells may suffer damage. In such cases, the symptoms may include:

  • Difficulties in walking
  • Changes in mood
  • Depression
  • Numbness or tingling in the toes and fingers
  • Disorientation, dementia or loss of memory

In infants, unless diagnosed and treated within a short time, the condition may cause acute and permanent damage to the nervous system. Women who follow a vegetarian diet and have just become mothers should get in touch with a doctor and have the level of B12 checked in their babies.

Vitamin B12 Deficiency Diagnosis

Doctors usually begin the diagnosis of this syndrome by asking patients about the symptoms that they have been experiencing. This is followed by a physical examination, in which physicians look for the following symptoms:

  • Paleness or yellowness of skin
  • Tachycardia, or abnormally fast heart rate
  • Changes in the eyes
  • Elevated body temperature
  • Enlarged spleen (Splenomegaly)

Patients are likely to exhibit even more symptoms. Based on the severity of the disorder, they may also experience pinpricks and loss of temperature sensations.

This may be followed by a number of tests, which include:

Blood tests

These exams reveal a deficiency in the level of B12 vitamin in blood. A lack of this component, and the presence of clinical symptoms of the disorder, confirm the diagnosis. Complete Blood Count (CBC) may indicate the presence of anemia.

Schilling test

In this method, a sufferer is administered with B12 in an injected or tablet form to assess whether it is being properly absorbed by the body.

Bone marrow test

In some cases, this exam may be carried out to diagnose the condition by allowing microscopic examination of cells.

Metabolite assessment

If the levels of Vitamin B12 in blood are borderline, blood may be tested for metabolites such as Methylmalonic acid and Homocysteine. This can help either affirm or rule out the diagnosis of B12 deficiency.

Vitamin B12 Deficiency Treatment

The aim of treatment of this disorder is to reverse the deficiency of the B12 vitamin. This is done by administering the supplements of the vitamin, in oral or injected form. In cases where the condition arises due to a dietary deficiency, the sufferer is to be educated on good sources of B12 and the importance of a well-balanced diet.

Those who refuse to consume animal products are prescribed Vitamin B12 supplements in an oral form for everyday usage. If the problem arises due to an underlying condition, treatment of the disorder is vital for successfully managing the disorder.

If the condition gives rise to complications, they need to be treated properly. Patients suffering from encephalopathy may get benefit from neuropsychological care. Those suffering from abnormalities in gait and balance may need physical and occupational therapy.

Vitamin B12 Deficiency Complications

Long-time sufferers of this condition tend to develop PA. PA sufferers have a higher risk of developing stomach cancers. If left without being treated, the disorder can result in acute neuropathies which include optic neuropathy, encephalopathy and myelopathy.

If you suspect yourself to be suffering from problems associated with Vitamin B12 Deficiency, consult a doctor and have a blood test done to analyze whether there is a reduction in the B12 levels of your body. Those deficient in Vitamin B12 may also suffer from a lack of other important nutrients. In such cases, the condition may be complicated by the occurrence of a number of other nutritional disorders.

In some rare cases, patients suffer from side effects arising due to Vitamin B12 supplementation. Very rarely, affected individuals suffer from hypersensitivity which is characterized by problems like:

  • Itching
  • Inflammation
  • Shock

Sometimes, extremely high doses may result in acne problems. Other rare side effects include:

  • Cardiac arrhythmia
  • Dizziness
  • Hot flushes
  • Nausea
  • Skin rash

Vitamin B12 Deficiency Prognosis

Affected people generally notice a significant improvement in their condition in 5-7 days, unless there is severe neurological involvement. Certain sufferers need vitamin therapy for as long as they live. Those who have suffered from motor abnormalities due to lack of Vitamin B12 for more than 6 months may only show a little response to treatment.

In acute cases, where treatment has been delayed for 6 months or more since the onset of nervous problems, affected people may suffer from permanent neurological problems and even have paralysis. In rare cases, death may also occur.

Those suffering from congenital cases of Vitamin B12 Deficiency have a less favorable outcome than those with acquired forms of the disorder.

Vitamin B12 Deficiency Prevention

Higher consumption of the following foods can help a majority of people avoid this condition:

  • Milk
  • Eggs
  • Seafood
  • Cheese
  • Poultry
  • Meat

If you do not consume animal products or suffer from a medical condition that prevents proper absorption of nutrients in your body, you are recommended to eat breakfast cereal containing B12 or have a B12-fortified multivitamin.

The amount of Vitamin B12 needed by a person depends on his or her age and gender. Other factors, such as pregnancy and ailments, are also essential to consider. Women who are in a stage of maternity or are breast-feeding their children, require higher amounts of the vitamin.


If you suspect yourself to be exhibiting the symptoms of Vitamin B12 Deficiency, consult a doctor to get your blood tested for this condition. If you test positive, seek treatment on an immediate basis to attain quick recovery. The faster you seek treatment, the quicker you can recover from this disorder.


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