Lack of vitamin
B12
Vitamin B12 is needed for the body to form red blood cells. If you have
too little B12, you can get anaemia. B12 is not produced in the body,
but you get it through food. B12 is found in food from the animal kingdom,
mainly in meat and dairy products.
Anemia can also be due to you having too little iron. You may also be anemic for other reasons.
Symptoms
The red blood cells have the task of transporting the oxygen from the
breathing air to all parts of the body. Oxygen is needed for most of
the body's functions, such as blood formation, metabolism and energy
production. This means that a lack of red blood cells can cause many
different types of symptoms.
Common symptoms of anemia:
You feel tired and listless.
You have difficulty concentrating.
You feel dizzy.
You feel that you are out of breath more easily than before.
You get palpitations.
You get a headache.
You get tinnitus.
Anemia due to too little B12 can also cause problems with the mucous
membranes. For example, there may be cracks in the corners of the mouth
or burning on the tongue. Burning on the tongue is because the gnarled
surface of the tongue disappears and instead it becomes smooth, red,
shiny and stings.
Anemia due to too little B12 can also cause problems from the nervous system. It can be in the form of tingling, numbness and impaired sensation starting in the feet. You may feel insecure when you walk and have impaired reflexes in the calves and soles of the feet. Severe B12 deficiency can also cause symptoms such as impaired memory, depression and impaired vision.
It is common for the symptoms of anemia due to too little B12 to increase slowly over several months and sometimes over several years.
When and where should I seek care?
Contact a healthcare center if you suspect you have anemia. You can
contact many receptions by logging in.
Call telephone number 1177 if you want healthcare advice. Then you can get help assessing symptoms or help with where to seek care.
Can I prevent anemia due to B12?
You who have gluten intolerance or have had gastric surgery may need
preventive treatment with B12, iron and folic acid. Discuss with your
doctor whether it may be relevant for you.
You who only eat vegan food may need supplements because vitamin B12 is mainly found in food from the animal kingdom.
Investigations and investigations
At the health center you can tell us about your symptoms. The doctor
then performs a physical examination. You may also submit a blood sample
that checks how much hemoglobin you have in your blood. It is abbreviated
Hb and is also called blood value. The test shows whether you have anemia
and what type of anemia you have.
When the doctor suspects that you have a B12 deficiency, he asks, for example, if the mucous membrane in the mouth burns and is red, if you have impaired sensation in your feet and if you have impaired reflexes.
Sometimes you can get a referral to a doctor who is a specialist in, for example, blood diseases.
Additional blood tests
The results of the first blood test show the doctor what type of anemia
you have and which further tests need to be taken. You may be deficient
in B12 or folic acid if the red blood cells are enlarged. The level
of these substances in the blood is then measured. Folic acid deficiency
can cause similar symptoms to vitamin B12 deficiency and you can also
have these deficiencies at the same time. There are also special blood
tests that can show if you have the disease pernicious anemia, which
causes a B12 deficiency.
Gastroscopy
Sometimes a gastroscopy is also performed. Then the doctor simultaneously
takes samples from the mucous membrane in the stomach for examination
under a microscope.
Bone marrow examination
You may also need to undergo a bone marrow examination. Then you are
numbed first in the skin and then deeper down towards the periosteum
at the place where the sample is to be taken. It is usually at the back
of the pelvic bone.
Treatment
You need to receive treatment with vitamin B12 if you are anemic due
to too little B12.
Tablets or syringes
You need to be treated with B12 for life if you have been diagnosed
with pernicious anemia. It is the most common cause of B12 deficiency
and is caused by a deficiency of the protein IF. You can get tablets
to take every day or injections every three months.
You always get shots at first if you have very low blood levels or if you have symptoms from the nerves in your legs.
It is very rare to have side effects from the treatment.
The blood count will quickly improve if you receive
treatment
The blood value usually rises quickly with the treatment. The value
usually becomes what it should be after a few weeks if you have moderate
anemia. It may take a couple of months if you have severe anemia with
a very low blood count. It often takes longer to get rid of symptoms
from the nervous system. Such symptoms can become permanent if they
have become severe.
It is rare to need
blood transfusions
The body has time to adapt because B12 deficiency usually causes the
blood value to drop slowly. This means that it is very rare to need
treatment with a blood transfusion even if the blood level is very low.
Blood transfusion is more common in cases of anemia that has occurred
quickly.
The lack of blood can be due to something else
If your blood count does not improve with the B12 treatment, it may
be because there is another cause of the anemia.
What happens in the body?
The body needs B12 to form red blood cells. Red blood cells contain
hemoglobin. It is an iron-containing substance that captures and transports
oxygen from the lungs out to the body's cells. In a person who is deficient
in B12, fewer red blood cells are formed than in a person without a
deficiency.
B12 is also needed for, for example, the nervous system and metabolism
to function.
You get B12 through food
Vitamin B12 cannot be manufactured in the body, but you get it through
the food you eat. When B12 enters the duodenum, it must bind to a special
protein in order to be absorbed into the body. The protein is called
intrinsic factor and is abbreviated IF.
B12 is found in food from the animal kingdom
Vitamin B12 is produced by microorganisms in nature, is eaten by animals
and is therefore available in human food. It is mainly found in meat
and dairy products. The largest amount is found in meat, liver, fish,
shellfish, eggs, milk and cheese.
You who only eat a vegan diet may find it difficult to get enough B12
through food. Some vegetable drinks such as soy drink, oat drink and
rice drink are fortified with B12. It may be good to choose one of these
if you do not eat meat or dairy products.
Be careful not to give rice drink to children under the age of six,
as rice may contain arsenic.
How much B12 do I need?
You who usually eat food from the animal kingdom get between 5 and 15
micrograms of vitamin B12 a day. Adults should get at least 2 micrograms
of vitamin B12 a day. Excess vitamin B12 is stored in the liver and
the stores last for several years.
What can cause anemia due to too little B12?
B12 deficiency can occur in several different ways.
Pernicious anemia
Pernicious anemia is due to a lack of the protein IF, which is formed
in the stomach and is needed for B12 to be absorbed into the body.
The most common cause of IF deficiency is a special form of inflammation
in the lining of the stomach that you may have had for a long time.
The inflammation is called chronic autoimmune gastritis. Then the own
immune system attacks the cells that produce IF and hydrochloric acid
in the stomach. It is a so-called autoimmune reaction. The reaction
can last a long time, sometimes for several years.
Other autoimmune diseases increase the risk of chronic autoimmune gastritis
People who have other so-called autoimmune diseases such as type 1 diabetes,
autoimmune thyroiditis and Addison's disease more often have this particular
form of inflammation in the stomach lining. Thus, they also have an
increased risk of pernicious anemia.
Chronic autoimmune gastritis is not related to gastritis.
How common is pernicious anemia and B12 deficiency?
Approximately one percent of the population in Sweden has pernicious
anemia. The disease is more common at an older age. It is unusual to
get pernicious anemia before the age of 30.
Pernicious anemia can be hereditary
If you have close genetic relatives with chronic autoimmune gastritis,
you have a greater risk of getting the inflammation yourself and thus
pernicious anemia.
There is also a very rare form of B12 deficiency that is caused by genes.
The disease means that you have a deficiency of the protein IF without
having chronic gastritis.
Disturbances in the bacterial flora
Another cause of B12 deficiency can be long-term treatment with certain
drugs. They can disrupt the intestinal bacterial flora so that the absorption
of B12 becomes worse. This applies to certain medicines for heartburn,
stomach ulcers, diabetes and systemic sclerosis.
Diseases of the intestine
Another cause of anemia due to too little B12 can be that you have an
intestinal disease that impairs the absorption of B12. Some examples
are gluten intolerance and inflammatory bowel diseases such as Crohn's
disease. It is common to also be deficient in iron and folic acid if
you are deficient in B12 due to an intestinal disease.
Stomach operations
You can become deficient in B12 if part of the stomach is disconnected,
for example during certain bariatric surgeries. The cells that produce
the protein IF may then be too few.
Influence and participate in your care
You can seek care at any health center or open specialist clinic you
want throughout the country. Sometimes a referral to open specialized
care is required.
In order for you to be able to participate in your care and treatment,
it is important that you understand the information you receive from
the healthcare staff.
You have the option of getting help from an interpreter if you do not
speak Swedish. You also have the option of getting help from an interpreter
if you have a hearing loss.
MORE AT 1177.SE
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• Eating vegetarian
• Fatigue
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Last updated:
2022-04-21
Editor:
Editor:
Peter Tuominen, 1177.se, the national editorial team
Examiner:
Gunnar Birgegård, doctor, professor of blood diseases, Academic
Hospital, Uppsala
Find on the page
• Symptoms
• When and where should I seek care?
• Can I prevent anemia due to B12?
• Investigations and investigations
• Treatment
• What happens in the body?
• What can cause anemia due to too little B12?
• Influence and participate in your care
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