Vitamin B12 or folate deficiency anaemia - Treatment 

Treating vitamin B12 or folate deficiency anaemia 

Vitamin B12 deficiency anaemia is often treated with regular injections of vitamin B12 

The treatment for vitamin B12 or folate deficiency anaemia depends on what is causing the condition.

Most cases can be easily treated with injections or tablets to replace the vitamin you are deficient in. 

Vitamin B12 deficiency anaemia

Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, in a form called hydroxocobalamin.

At first, you will have these injections every other day for two weeks, or until your symptoms have stopped improving. Your GP or nurse will give the injections.

After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet. The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which is not related to your diet.

Read more about the causes of vitamin B12 or folate deficiency.

Diet-related

If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals. Alternatively, you may need to have an injection of hydroxocobalamin twice a year.

People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.

Although it is less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved.

Good sources of vitamin B12 include:

  • meat
  • salmon and cod
  • milk and other dairy products
  • eggs

If you are a vegetarian or vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract (including Marmite), as well as some fortified breakfast cereals and soy products.

Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain.

Not diet-related

If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, you will usually need to have an injection of hydroxocobalamin every three months for the rest of your life.

If you have had neurological symptoms (symptoms that affect your nervous system, such as numbness or tingling in your hands and feet) caused by a vitamin B12 deficiency, you will be referred to a haematologist, and you may need to have injections every two months. Your haematologist will advise on how long you need to keep taking the injections.

For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer.

If you need regular injections of vitamin B12, cyanocobalamin would need to be given once a month, whereas hydroxocobalamin can be given every three months.

Cyanocobalamin injections are therefore not recommended and not routinely available on the NHS. However, if you need replacement tablets of vitamin B12, these will be cyanocobalamin.

Read more about hydroxocobalamin and cyanocobalamin.

Folate deficiency anaemia

To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake.

Good sources of folate include:

  • broccoli
  • Brussels sprouts
  • asparagus
  • peas
  • chickpeas
  • brown rice

Most people will need to take folic acid tablets for about four months. However, if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer – possibly for life.

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they are normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency. If a vitamin B12 deficiency is not detected and treated, it could affect your nervous system.

Monitoring your condition

To ensure your treatment is working, you may need to have further blood tests.

Around 10 days after starting treatment, a blood test is often carried out to assess whether treatment is working by checking your haemoglobin level and the number of the immature red blood cells (reticulocytes) in your blood. Another blood test may also be carried out after approximately eight weeks to confirm your treatment has been successful.

If you have been taking folic acid tablets, you may be tested again once the treatment has finished (usually after four months).

Most people who have had a vitamin B12 or folate deficiency will not need further monitoring unless their symptoms return, or their treatment is ineffective. If your GP feels it is necessary, you may have to return for an annual blood test to see whether your condition has returned.

Page last reviewed: 21/05/2014

Next review due: 21/05/2016

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