Vitamin B12 deficiency (pernicious anaemia)

Question 1

The clinical features are

Answer 1

anaemia (macrocytic)

weight loss

neurological symptoms, esp. a polyneuropathy

The serum vitamin B12 is below the normal level.

Question 2

Replacement therapy

Answer 2

Vitamin B12 (1 mg) IM injection:

• body stores (3–5 mg) are replenished after 10 injections given every 2–3 d + oral folate 5 mg (0) d

Maintenance with 1 mg injections every 3 mths