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Vitamin B12 or folate deficiency anemia

B12 or folate deficiency can result in Anemia.
B12 deficiency can result in megaloblastic anemia.

When the count of red blood cells decreases or the quantity of hemoglobin in the blood decreases, the condition is called Anemia. Anemia may occur for various reasons.  Vitamin B12 or folic acid ( vitamin B9 ) deficiency causes the red blood cells to enlarge abnormally. This anemia is called Vitamin B12 or folate deficiency anemia. These bulky red blood cells do not function normally. This anemia is more common in older people.

Learn about Iron Deficiency Anemia


The deficiency of Vitamin B12 and folate in the body may be caused due to a variety of reasons.

  • Lack of vitamins in the diet: The human body generally has sufficient Vitamin B12 and folate stores. Deficiency symptoms occur only after a period of time and only in severely malnourished people. Vegans who don’t eat any animal products are also susceptible to it.
  • Malabsorption: Most cases of vitamin B12 or folate deficiency occur due to malabsorption. After intake in the stomach, the acid releases vitamin B12. The small intestine binds with intrinsic factor (IF) released by the stomach’s parietal cells. The b12-IF complex then binds with a carrier protein to be absorbed. Interference in any of these processes impairs b12 absorption.
  • Pernicious anemia: In this condition, parietal cells are damaged. As a result, IF production is impaired, which causes malabsorption of vitamin B12.
  • Intestinal conditions: Crohn’s disease, ulcerative colitis, and celiac disease affect the lining of the intestine, thereby limiting the absorption of vitamin B12.
  • Parasitic infestation: It also causes reduced absorption of vitamin B12.
  • Surgical procedure: Some surgical procedures involve removing a portion of the stomach. These procedures cause gastric bypass, which reduces the absorption of vitamin B12.
  • Medicines: Medicines result in decreased absorption of vitamin B12. These include :
  1.  Acid reflux medicine like omeprazole.
  2. Anti-epilepsy medication like phenytoin.
  3. Anticancer drugs such as methotrexate.
  • Elevated need
  1. In pregnancy, the requirement of the body for various nutrients increases for the growth of the fetus. Deficiency of folic acid during pregnancy can result in neural tube defects in children.
  2. Heavy alcohol intake causes vitamin B12 and folate deficiency due to poor nutrition. It also inhibits the release of vitamin B12 from food.

Symptoms of vitamin B12 or folate deficiency

Vitamin B12, along with having a role in the production of red blood cells, also has an essential role in keeping the nerves healthy. Symptoms you may experience include:

  •  Fatigue and lack of energy are caused by the inability of red blood cells to carry oxygen to all body parts.
  •  Pins sensation in the hands: It is due to irritation of nerves.
  •  Pale skin and headache: It is due to the reduced oxygen supply.
  •  Palpitating of the heart and shortness of breath: The heart tries to compensate for reduced red blood cell function by pumping vigorously.
  •  Inflamed tongue and ulcers in the mouth: It occurs due to vitamin B12 deficiency.
  •  Reduced sensation of taste, touch, and ability to feel pain.
  • Reduced vision, irritability, and depression.
  • Weakness of muscle due to folate deficiency.

Diagnosis of vitamin B12 or folate deficiency

Your doctor will diagnose vitamin B12 and folate deficiency anemia based on your medical history of symptoms and physical examination. He will examine you to find out the underlying cause of anemia.

Blood test

It consists of taking a small amount of blood from your vein and performing various tests.

  • Hemoglobin: The amount of hemoglobin in the case of an anemic person is decreased. It is <10 mg/dl for both sexes.
  • Peripheral smear: It will detect abnormally large red blood cells.
  • Vitamin B12 in the blood: It is lower in the case of vitamin B12 deficiency.
  • Folic acid levels: Folic acid levels are reduced in the body.

Test to find the underlying cause

Detection of antibodies against parietal cells

These antibodies are present in pernicious anemia, which destroys parietal cells.

  • Intrinsic factor antibody: The presence of intrinsic factor antibody indicates impaired intrinsic factor function.
  • Gastrin: Gastrin levels increase in pernicious anemia. The gastrin hormone regulates gastric acid production.


There are ways you may try to prevent the condition from happening or recurring.

  • Increasing dietary intake of vitamin B12: Meat, eggs, and milk products contain the right amount of vitamin B12. You may take soy products and cereals fortified with vitamin B12 if you are vegan.
  • Increasing dietary intake of folate: Green vegetables like broccoli, peas, and chickpeas are a good source of folate.

Eggs and milk products contain the right amount of vitamin B12.

vitamin B12 or Folate deficiency anemia: Eggs, and milk products contain the right amount of vitamin B12.
Eggs and milk products contain the right amount of vitamin B12.


Vitamin B12 deficiency and folic acid deficiency anemia generally occur together. Treatment consists of vitamin B12 injection and folate tablets.

Treating vitamin B12 deficiency anemia

To treat vitamin B12 deficiency, a chemical called hydroxocobalamin is administered. First, you will be injected every alternate day for about two weeks. After this, the dose of injection depends upon the reason for vitamin B12 deficiency.

  • Diet-related: Suppose your condition is due to insufficient dietary intake. In that case, your doctor may ask you to take vitamin B12 tablets daily between meals or vitamin B12 injections twice a year. Vegans may need vitamin B12 tablets for life.
  • Not related to diet: Suppose your condition is not related to diet. In that case, you will be prescribed an injection of vitamin B12 to be administered every two months for the rest of your life.

Folic acid deficiency anemia treatment

You will be prescribed folic acid tablets to be taken daily. Mostly, you need to have them for four months. Still, it depends upon underlying conditions. Vitamin B12 level needs to be checked before starting folic acid intake. Intake of folic acid alone may mask vitamin B12 deficiency, which could later damage your nervous system.

Monitor your condition

Some blood tests need to be conducted at about two weeks and then usually after four months to check if the treatment is successful.

  • E55.9 is a specific/billable ICD-10-CM code that can indicate a diagnosis for reimbursement purposes.
  • The 2024 edition of ICD-10-CM E55.9 became effective on Ist October, 2023.
  • The American ICD-10-CM version of E55.9 and other international versions of ICD-10 E55.9 may differ.


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