Vitamin B12 or folate deficiency anaemia

About

Vitamin B12 or folate deficiency anaemia is a type of anaemia that occurs when there is a deficiency of either vitamin B12 or folate in the diet. Symptoms of this condition include fatigue, shortness of breath, pale skin, heart palpitations, and dizziness. A blood test is usually used to diagnose this condition. Treatment of vitamin B12 and folate deficiency anaemia usually involves supplementation with either or both of these vitamins. Eating foods that are rich in vitamin B12 and folate, such as fish, eggs, green leafy vegetables, and fortified cereals, can also help.

Symptoms

Common symptoms of Vitamin B12 or folate deficiency anemia can include:

Fatigue, weakness, or lightheadedness
Paleness or a yellowing of the skin
Shortness of breath
Heart palpitations or a rapid heartbeat
Sore mouth and tongue
Loss of appetite
Diarrhea or constipation
Weight loss
Nerve problems, such as numbness or tingling in the hands and feet
Depression
Problems with memory, understanding, or concentration

Causes

The most common known causes of Vitamin B12 or folate deficiency anaemia are:

Poor dietary intake of Vitamin B12 or folate, which can be caused by certain dietary restrictions (vegan and vegetarian diets) or an inadequate balanced diet.
Impaired absorption of Vitamin B12 or folate due to certain medical conditions like celiac disease or pernicious anemia, surgery or cancer treatments that impact the stomach.
Hyposplenism, a condition where the spleen is not working as it should, leading to reduced absorption of Vitamin B12 and folate into the body.
Long-term use of certain drugs like proton pump inhibitors, antacids and metformin which can interfere with absorption of Vitamin B12 and folate.
Alcoholism, which can lead to poor nutrition and impaired absorption of Vitamin B12 and folate.
Increased demand for Vitamin B12 and folate due to certain medical conditions such as pregnancy, growth or tumors.

Risk factors

The risk factors for Vitamin B12 or folate deficiency anaemia include:

Diet: Long-term vegan or vegetarian diets can lead to vitamin B12 deficiency, as this type of diet typically excludes foods that are decisive sources of the vitamin.
Age: As people age, the ability to absorb vitamin B12 from food diminishes, leading to a higher risk of deficiency.
Gastrointestinal Diseases: Certain conditions such as celiac disease, Crohn’s disease, bacterial overgrowth, and atrophic gastritis can interfere with the absorption of vitamin B12 and lead to a deficiency.
Surgery: The removal or bypassing of the stomach or small intestine can also interfere with the absorption of vitamin B12 and lead to a deficiency.
Medications: Long-term use of certain medications such as proton-pump inhibitors (PPIs), acid-suppressing agents, or H2 blockers can reduce the absorption of vitamin B12 from food.
Other Diseases: Diseases that affect the absorption of vitamin B12, such as an autoimmune disorder called pernicious anemia, can cause a deficiency.

Diagnosis

Vitamin B12 or folate deficiency anaemia is typically diagnosed with a physical exam and a blood test. During the physical exam, your doctor will look for signs of anaemia including pale or yellowish skin, rapid heart rate, shortness of breath, and swollen tongue. The blood test will measure the levels of vitamin B12 and folate in your system to determine if they are too low. Your doctor may also order a test to measure levels of other related vitamins, iron and red blood cells. Depending on the cause of the deficiency, additional tests may also be done, such as a thyroid test or an MRI.

Sub-types

Vitamin B12 and folate deficiency anaemias are distinguished by their underlying causes, which can be either dietary or due to an underlying health condition.

Dietary Deficiency Anaemia: Dietary deficiency anemias are caused by an insufficient intake of vitamin B12 or folate through dietary means. This can be caused by not eating enough foods that contain these essential vitamins or due to an inability to absorb them from the gastrointestinal tract.
Pernicious Anaemia: Pernicious anaemia is caused by an autoimmune condition in which the body’s immune system attacks and destroys the cells in the stomach lining, preventing them from producing a substance called intrinsic factor. This then prevents the absorption of Vitamin B12 from the diet, resulting in an anaemic state.
Macrocytic Anaemia: Macrocytic anaemia is caused by abnormal production of red blood cells, resulting in a decrease in cell size. This is due to a deficiency of either vitamin B12 or folate, which are both essential for DNA synthesis in the bone marrow and the normal production of red blood cells.
Megaloblastic Anaemia: Megaloblastic anaemia is caused by an abnormally fast rate of red blood cell production, resulting in an increase in cell size. This is usually due to a deficiency of either vitamin B12 or folate, which are both necessary for DNA synthesis in the bone marrow.
Hemolytic Anaemia: Hemolytic anaemia is caused by a breakdown of red blood cells due to an underlying condition, such as a genetic disorder. Vitamin B12 and folate deficiencies have been known to contribute to a decrease in the body’s ability to produce healthy red blood cells, resulting in an anaemic state.

Treatments

Treatment options for vitamin B12 or folate deficiency anaemia depend on the underlying cause of the anaemia.

Common treatment options include:

Increasing your intake of foods rich in vitamin B12 and/or folate. Examples include beef, salmon, fortified breakfast cereals, dark green leafy vegetables, eggs, and dairy products.
Taking a vitamin B12 or folate supplement. Your doctor can recommend the right dosage for you.
Receiving vitamin B12 injections. This is the quickest way to restore the body’s vitamin B12 levels.
Taking folic acid supplements. These may be prescribed if your anaemia is due to a folate deficiency.
Making dietary changes to reduce the amount of consuming foods that are low in nutritional value.
Having your doctor monitor your iron levels and recommend iron supplements if necessary.

In addition to the above, treating any underlying medical condition that may be causing the vitamin B12 or folate deficiency is also necessary.

It is important to talk to your doctor before attempting any of the above treatments, as the correct dosage and treatment plan will depend on the underlying cause.

Prevention

Eat a balanced diet with foods that are rich in Vitamin B12 and folate, such as fish, poultry, eggs, dairy products, legumes, and leafy green vegetables.
Consider supplementing with Vitamin B12 or folate.
If you are over the age of 50, ask your doctor to test your Vitamin B12 and folate levels, as these are more common in older adults.
Avoid drinking alcohol excessively, as this can interfere with the absorption of certain vitamins.
If you are on any medications, ask your doctor whether they can be affecting your Vitamin B12 or folate absorption.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of Vitamin B12 and folate deficiency anaemias. Women are more likely to be deficient in both vitamins due to increased requirements during pregnancy, which can lead to an increased risk of developing an anaemia. In addition, women may also be more likely to experience neurological symptoms due to a Vitamin B12 deficiency, such as peripheral neuropathy, numbness and tingling, or difficulty walking.

Men are more likely to develop megaloblastic anaemia due to Vitamin B12 or folate deficiencies, which is characterised by larger, immature red blood cells. It is also possible for men to experience similar neurological symptoms to women, but they are less common.

When it comes to management, Vitamin B12 and folate deficiency anaemias are generally treated in the same manner. Treatment typically includes dietary changes, supplementation with B12 or folate, and in some cases, injections. However, women who are pregnant or planning to become pregnant may require higher doses due to increased requirements. Furthermore, women of childbearing age should be screened for Vitamin B12 or folate deficiency at regular intervals.

Nutrition

Nutrition plays a critical role in the management of Vitamin B12 and folate deficiency anaemia. Adequate amounts of Vitamin B12 and folate, which are present in a variety of foods, are essential for the production of red blood cells and maintaining healthy oxygen carrying capacity. Deficiencies in either nutrient can lead to a low red blood cell count, which may cause symptoms of anaemia. To treat anaemia due to Vitamin B12 and folate deficiencies, a diet that includes foods high in these nutrients is often recommended. This may include animal sources of B12 such as liver, eggs, fish, dairy products and fortified foods, as well as folate rich foods such as green leafy vegetables, legumes and fortified grains. Dietary supplementation may also be used to treat these deficiencies.

Physical Activity

Physical activity can have a beneficial impact on vitamin B12 and folate deficiency anaemia. Exercise can help to normalize levels of these two essential vitamins. It increases blood flow and brings more oxygen to the cells, allowing the body to better absorb these vitamins. Exercise also helps to metabolize stored fat, which increases the absorption of essential nutrients. Additionally, physical activity helps to reduce fatigue, which is a common symptom of both vitamin B12 and folate deficiency anaemia. Exercise can also help to reduce inflammation throughout the body, which can improve the effectiveness of treatment. Therefore, regular physical activity should be included in an overall treatment plan for people with these types of anemia.