Sometimes in patients who have undergone removal of the stomach (most probably from severe peptic ulceration) a similar situation can occur. However, as the liver can store vitamin B12 with amounts that may last up to five years, it may be several years after surgery that the symptoms will commence. In other patients who have bowel disorders, there may be interference in folic acid absorption. A condition called Crohn’s disease may be present, or there may have been surgical removal of part of the bowel, coeliac disease, sprue and certain other disorders.
During pregnancy there is a large increase in the body’s need for folic acid. For this reason, folic acid is now given routinely together with iron to all women during pregnancy.
Some patients on drug medication for other conditions have their folic-acid supplies adversely affected. This ma y include drugs taken for epilepsy, and certain sulfa drugs, to name some of the more common ones implicated.
Apart from affecting the red cells. these deficiencies may also adversely affect the production of the white cells and platelets, both of which may be reduced in numbers. This in turn may produce serious symptoms and conditions attributed to this.
Vitamin B12 Deficiency Symptoms
The symptoms will be a combination of the usual symptoms of anaemia, plus symptoms of the underlying cause. A glossitis (sore, red tongue) usually occurs as well. The blood picture shows abnormal cells, and there is a reduced number of white cells and platelets.
Inadequate vitamin B12 may also react adversely on the nervous system, producing a serious condition called subacute combined degeneration of the spinal cord. This also produces symptoms that are described under the nervous system. It is essential that this condition be treated early, for damage to the cord may be rectified with prompt early treatment.
But if left, these changes may be permanent, much to the discomfort of the patient. Tests are available that directly measure the blood levels of folic acid and vitamin B12. (Refer to the section on vitamins for a list of foods rich in these substances.)
Vitamin B12 Deficiency Treatment
Therapy is very satisfactory, and the results relatively prompt. Once the diagnosis has been established, the doctor will most likely order folic acid in tablet form, commonly giving 5 mg three times a day.
Vitamin B12 is usually given in the form of an injection. Over the years the exact chemical formulation has changed. It used to be cyanocobalamin. often injected weekly by the doctor or district nurse. However. this has now changed to a related product called hydroxocobalamin 1000 (equals 1 000 micrograms/ ml) that is claimed to offer adequate protection if given once each three months by injection. This is now the routine in Australia and New Zealand for pernicious anaemia patients. Nevertheless, many older patients claimed they felt better on their monthly or bimonthly shots of B12 in the older form.
The injections may he necessary for the rest of the patient’s life. They are painless and adverse side effects are extremely uncommon. It is a small price to pay for a supplement that yields such dramatic and beneficial results.
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Vitamin B12 Deficiency Symptoms