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Article: Review of vitamin B12 deficiency management in a family medicine clinic

TitleReview of vitamin B12 deficiency management in a family medicine clinic
Authors
KeywordsPrimary care
Vitamin B12
Pernicious anaemia
Issue Date2011
Citation
Hong Kong Practitioner, 2011, v. 33, n. 2, p. 64-71 How to Cite?
AbstractObjective: To review the current practice for patients diagnosed with vitamin B12 deficiency in a family medicine clinic. Design: Retrospective case notes review. Subjects: Patients attending the authors' family medicine clinic and prescribed with vitamin B12 supplement. Main outcome measures: Information collected included patient demographics, history of gastrectomy or significant gastric disease, diet history, auto-antibody levels, medications prescribed, vitamin B12 levels (pre-and post-), and reasons for checking B12 levels. Results: During the study period, 170 patients had been prescribed with any form of vitamin B12. In 47.6% of patients, testing was performed as screening among diabetics taking metformin. The mean baseline serum vitamin B12 level at diagnosis was 146.3pmol/L. Baseline levels were greater than 179pmol/L among 13% of patients. 73% and 27% were initially put on oral route and parenteral supplementation respectively. Among those on oral supplementation initially, 4% were changed to the parenteral route. Among those on parenteral supplementation initially, 35% were changed to the oral route. There was variation with regards to whether a loading regime was used or not among those receiving intramuscular injection. For those with a baseline level less than 200pmol/L, oral supplementation was comparable to injection with at least 90% cases attaining levels greater than 200pmol/L. Both routes achieved significant increases in B12 level (222.6 and 489 respectively). The commonest causes of B12 deficiency identified were metformin-related, followed by pernicious anaemia and diet related to insufficient meat intake. In 52% of patients, either one or both of anti-IF and anti-PA were checked. Subsequently 21 patients were diagnosed with pernicious anaemia. Among the 21 cases of pernicious anaemia, only 10 cases were more likely to have a true diagnosis of pernicious anaemia (anti-IF greater than 20 RU/ml). However, among these, three patients were prescribed with oral vitamin B12 and resulted in a significant mean B12 increase of 294 pmol/L. Conclusion: Vitamin B12 deficiency is not an uncommon condition seen in primary care setting. Pernicious anaemia may be under-diagnosed when there are other possible concomitant causes. Among those with pernicious anaemia, oral supplementation may be effective in restoring vitamin B12 level, although a minority of patients may still be under-treated due to suboptimal doses. Future studies will be needed to help setting up guidelines so that front-line doctors can manage patients in a more effective manner.
Persistent Identifierhttp://hdl.handle.net/10722/205748
ISSN
2015 SCImago Journal Rankings: 0.101

 

DC FieldValueLanguage
dc.contributor.authorLee, ManKei-
dc.contributor.authorWong, PakKin-
dc.contributor.authorKung, Kenny-
dc.contributor.authorLam, Augustine-
dc.date.accessioned2014-10-06T08:02:18Z-
dc.date.available2014-10-06T08:02:18Z-
dc.date.issued2011-
dc.identifier.citationHong Kong Practitioner, 2011, v. 33, n. 2, p. 64-71-
dc.identifier.issn1027-3948-
dc.identifier.urihttp://hdl.handle.net/10722/205748-
dc.description.abstractObjective: To review the current practice for patients diagnosed with vitamin B12 deficiency in a family medicine clinic. Design: Retrospective case notes review. Subjects: Patients attending the authors' family medicine clinic and prescribed with vitamin B12 supplement. Main outcome measures: Information collected included patient demographics, history of gastrectomy or significant gastric disease, diet history, auto-antibody levels, medications prescribed, vitamin B12 levels (pre-and post-), and reasons for checking B12 levels. Results: During the study period, 170 patients had been prescribed with any form of vitamin B12. In 47.6% of patients, testing was performed as screening among diabetics taking metformin. The mean baseline serum vitamin B12 level at diagnosis was 146.3pmol/L. Baseline levels were greater than 179pmol/L among 13% of patients. 73% and 27% were initially put on oral route and parenteral supplementation respectively. Among those on oral supplementation initially, 4% were changed to the parenteral route. Among those on parenteral supplementation initially, 35% were changed to the oral route. There was variation with regards to whether a loading regime was used or not among those receiving intramuscular injection. For those with a baseline level less than 200pmol/L, oral supplementation was comparable to injection with at least 90% cases attaining levels greater than 200pmol/L. Both routes achieved significant increases in B12 level (222.6 and 489 respectively). The commonest causes of B12 deficiency identified were metformin-related, followed by pernicious anaemia and diet related to insufficient meat intake. In 52% of patients, either one or both of anti-IF and anti-PA were checked. Subsequently 21 patients were diagnosed with pernicious anaemia. Among the 21 cases of pernicious anaemia, only 10 cases were more likely to have a true diagnosis of pernicious anaemia (anti-IF greater than 20 RU/ml). However, among these, three patients were prescribed with oral vitamin B12 and resulted in a significant mean B12 increase of 294 pmol/L. Conclusion: Vitamin B12 deficiency is not an uncommon condition seen in primary care setting. Pernicious anaemia may be under-diagnosed when there are other possible concomitant causes. Among those with pernicious anaemia, oral supplementation may be effective in restoring vitamin B12 level, although a minority of patients may still be under-treated due to suboptimal doses. Future studies will be needed to help setting up guidelines so that front-line doctors can manage patients in a more effective manner.-
dc.languageeng-
dc.relation.ispartofHong Kong Practitioner-
dc.subjectPrimary care-
dc.subjectVitamin B12-
dc.subjectPernicious anaemia-
dc.titleReview of vitamin B12 deficiency management in a family medicine clinic-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.scopuseid_2-s2.0-80051741658-
dc.identifier.volume33-
dc.identifier.issue2-
dc.identifier.spage64-
dc.identifier.epage71-

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