B12/folate deficiency

Always treat B12 deficiency first - giving patients folic acid when they have a B12 deficiency can lead to subacute combined degeneration of the cord, (demyelination in the spinal cord with severe neurological complications).

 

B12 deficiency causes macrocytic anaemia - DNA synthesis interference so produces large immature RBCs.

• Pernicious anaemia (autoimmune condition - antibodies produced against intrinsic factor)
• Insufficient dietary B12 - particularly vegan diet
• Medications that reduce B12 absorption (e.g. PPIs, metformin)

Neuropathy

• Peripheral neuropathy
• Loss of vibration 
• Loss of proprioception 
• Visual changes
• Mood changes