From the Guidelines
A Vitamin B12 level of 157 pg/mL is considered low and requires immediate supplementation with hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks, as per NICE recommendations 1. Given the low Vitamin B12 level, it is crucial to initiate treatment promptly to prevent further complications.
- The treatment approach should follow the guidelines outlined by NICE, which recommend administering hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks for individuals with no neurological involvement 1.
- After the initial treatment phase, maintenance treatment with 1 mg intramuscularly every 2–3 months lifelong is recommended to ensure that the Vitamin B12 levels remain within the normal range 1.
- It is essential to note that folic acid should not be given first, as it may mask underlying Vitamin B12 deficiency and precipitate subacute combined degeneration of the spinal cord 1.
- If there is possible neurological involvement, such as unexplained sensory and/or motor and gait symptoms, urgent specialist advice from a neurologist and haematologist should be sought 1.
- The underlying cause of the deficiency should be identified and addressed to prevent future deficiencies.
From the Research
Treatment for Vitamin B12 Level of 157
The treatment for a Vitamin B12 level of 157 is primarily focused on addressing the underlying cause of the deficiency and replenishing Vitamin B12 stores.
- Oral administration of high-dose Vitamin B12 (1 to 2 mg daily) is as effective as intramuscular administration for correcting anemia and neurologic symptoms 2.
- Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe neurologic symptoms 2.
- A study on oral Vitamin B12 supplementation in pernicious anemia found that 88.5% of patients were no longer deficient in Vitamin B12 after 1 month of oral cyanocobalamin supplementation at a dosage of 1000 μg/d 3.
Diagnosis and Assessment
- Initial laboratory assessment should include a complete blood count and serum Vitamin B12 level 2.
- Measurement of serum methylmalonic acid should be used to confirm deficiency in asymptomatic high-risk patients with low-normal levels of Vitamin B12 2.
- Diagnostic biomarkers for Vitamin B12 status include decreased levels of circulating total Vitamin B12 and transcobalamin-bound Vitamin B12, and abnormally increased levels of homocysteine and methylmalonic acid 4.
Management and Prevention
- Management depends on Vitamin B12 supplementation, either via high-dose oral routes or via parenteral administration 4.
- Patients older than 50 years and vegans or strict vegetarians should consume foods fortified with Vitamin B12 or take Vitamin B12 supplements to improve absorption rates 2.
- Patients who have had bariatric surgery should receive 1 mg of oral Vitamin B12 per day indefinitely 2.