***UPDATE JUNE 2025***
The BNSSG Vitamin B12 Deficiency Guidelines have now been published and replace previous guidelines. They include advice for primary care on testing, interpretation, further investigation, treatment and follow up.
Patients with vitamin B12 or folate deficiency do not normally require referral for haematology outpatient assessment.
Haematology advice and guidance can be requested if uncertainty regards management persist.
Vitamin B12 testing should be avoided in pregnancy as results are unreliable (levels naturally decrease in pregnancy). If clinical suspicion of deficiency is strong, consider testing but interpret the results with caution. Discussion with the laboratory and additional tests may be needed. An alternative approach may be a short course of therapy and reassessment post-pregnancy.
Further guidance on testing and treatment of vitamin B12 in pregnancy is available in the Guidelines.
See also the Folic acid and vitamin B12 in pregnancy page.
See appendix 1 of the Guidelines.
Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
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