Skip to main content

Vitamin B12 Deficiency

  • Chapter
  • First Online:
Hematology in the Adolescent Female

Abstract

Vitamin B12 (cobalamin) deficiency and its related hematological and neurological manifestations, of which pernicious and megaloblastic anemia are the most recognized entities, have puzzled the medical community for over a century. These conditions are described in all ages, race and ethnicities, continents, and socioeconomic groups. Among the etiologies identified in vitamin B12 deficiency, nutritional deficiency, including restrictive diets due to access to appropriate food items, food or oral aversion, or personal choice, is recognized in developed and developing countries. Other etiologies include inherited or genetic defect in the metabolism of vitamin B12, immune-mediated, or absorption-related defects. Understanding the pathophysiology of this phenomenon has allowed us to provide the adequate treatment to reverse the changes in the affected systems successfully.

The emphasis of this chapter focuses in the pathophysiology, clinical manifestations, laboratory diagnosis, and treatment of the most common causes of vitamin B12 deficiency and its hematological signs and symptoms as they pertain in particular to adolescent females.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Anthony AC. Megaloblastic anemias. In: Hoffman R, Benz EJ, Shattil SJ, et al., editors. Hematology: basic principles and practice. New York: Churchill Livingstone; 1991. p. 392–422.

    Google Scholar 

  2. Chanarin I. The megaloblastic anaemias. London: Blackwell Scientific Publications; 1979. p. 225–6.

    Google Scholar 

  3. Graham SM, Arvela OM, Wise GA. Long-term neurological consequences of nutritional vitamin B12 deficiency in infants. J Pediatr. 1992;121:710–4.

    Article  CAS  Google Scholar 

  4. Evim MS, Erdöl S, et al. Long-term outcome in children with vitamin B12 deficiency. Turk J Hematol. 2011;28:286–93.

    Article  CAS  Google Scholar 

  5. Kapoor A, Baig M, et al. Neuropsychiatric and neurological problems among Vitamin B12 deficient young vegetarians. Neurosciences. 2017;22(3):228–32.

    Article  Google Scholar 

  6. Combe JS. History of a case of anaemia. Trans Med Chir Soc Edin. 1824;1:194.

    CAS  Google Scholar 

  7. Addison T. Anaemia: disease of the supra-renal capsules. London Med Gaz. 1849;43:517.

    Google Scholar 

  8. Wintrobe MM. Hematology, the blossoming of a science: a story of inspiration and effort. Philadelphia: Lea & Febiger; 1985.

    Google Scholar 

  9. Chanarin I. A history of pernicious anemia. Br J Haematol. 2000;111:407–15.

    Article  CAS  Google Scholar 

  10. Watkins D, Whitehead VM, Rosenblatt DS. Megaloblastic anemia. In: Orkin SH, et al., editors. Nathan and Oski: Hematology of Infancy and Childhood. 7th ed. Philadelphia: Saunders Elsevier; 2009. p. 467–520.

    Google Scholar 

  11. Smith E. Purification of anti-pernicious anemia factors from liver. Nature. 1948;161:638–9.

    Article  CAS  Google Scholar 

  12. Kamen BA, Meyers P. Megaloblastic anemias. In: Miller DR, Miller LP, et al., editors. Blood disease of infancy and childhood: in the tradition of CH smith. 7th ed: Mosby; 1995. p. 220–39.

    Google Scholar 

  13. http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2019/DRI-Tables-2019/2_RDAAIVVE.pdf?la=en.

  14. Pawlak R, Parrott SJ, et al. How prevalent is vitamin B12 deficiency among vegetarians? Nutr Rev. 2013;71(2):110–7.

    Article  Google Scholar 

  15. Carmel R, Watkins D, Rosenblatt DS. Megaloblastic anemia. In: Orkin SH, et al., editors. In Nathan and Oski: Hematology of Infancy and Childhood. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 308–56.

    Google Scholar 

  16. Wright JD, Bialostosky K, Gunter EW, Carroll MD, Najjar MF, Bowman BA, et al. Blood folate and vitamin B12: United States, 1988–94. Vital Health State. 1998;11:1–78.

    Google Scholar 

  17. Rasmussen SA, Fernhoff PM, et al. Vitamin B12 deficiency in children and adolescents. J Pediatr. 2001;138(1):10–7.

    Article  CAS  Google Scholar 

  18. Verma S. Vitamin B12 and folate deficiency amongst adolescents. Int J Contemp Med Res. 2017;4(8):1755–7.

    Google Scholar 

  19. Kirby M, Danner E. Nutritional deficiencies in children on restricted diets. Pediatr Clin N Am. 2009;56:1085–103.

    Article  Google Scholar 

  20. Moilanen BC. Vegan Diets in Infants. Children and Adolescents Pediatrics in Review. May 2004;25(5):174–6.

    PubMed  Google Scholar 

  21. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food Nutr Bull. 29(2 supplement) © 2008, The United Nations University S238–44.

    Google Scholar 

  22. Ashkenazi S, Weitz R, et al. Vitamin B12 deficiency due to a strictly vegetarian diet in adolescence. Clin Pediatr (Phila). 1987;26:662–3.

    Article  CAS  Google Scholar 

  23. Bar-Sella P, Rakover Y, Ratner D. Vitamin B12 and folate levels in long term vegans. Isr J Med Sci. 1990;26:309–12.

    CAS  PubMed  Google Scholar 

  24. Pinhas-Hamiel O, Doron-Panush N, et al. Obese children and adolescents: a risk group for low vitamin B12 concentration. Arch Pediatr Adolesc Med. 2006;160:933–6.

    Article  Google Scholar 

  25. Ho M, Halim JH, et al. Vitamin B12 in obese adolescents with clinical features of insulin resistance. Nutrients. 2014;6(12):5611–8.

    Article  CAS  Google Scholar 

  26. Sun Y, Sun M, et al. Inverse association between serum vitamin B12 concentration and obesity among adults in the United States. Front Endocrinol. 2019; https://doi.org/10.3389/fendo.2019.00414.

  27. Baltaci D, Kutlucan A, et al. Association of vitamin B12 with obesity, overweight, insulin resistance and metabolic syndrome and body fat composition: primary care-based study. Med Glas (Zenica). 2013 Aug;10(2):203–10.

    Google Scholar 

  28. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299–326.

    Article  CAS  Google Scholar 

  29. Furszyfer J, WM MC, et al. On the increased association of Graves’disease with pernicious anemia. Mayo Clin Proc. 1971;46:37–9.

    CAS  PubMed  Google Scholar 

  30. Carmel RC, Johnson CS. Racial patterns in pernicious anemia. Early age at onset and increased frequency of intrinsic-factor antibody in black women. N Engl J Med. 1978;298:647–50.

    Article  CAS  Google Scholar 

  31. Singh C, Pukhraj G, et al. A prospective, cross sectional open label clinicoepidemiological study of vitamin B12 deficiency in adolescent children. Int J Contemp Pediatr. 2018 Jul;5(4):1468–73.

    Article  Google Scholar 

  32. Stabler SP. Vitamin B12 Deficiency. N Engl J Med. 2013;368:149–60.

    Article  CAS  Google Scholar 

  33. Koury MJ, Ponka P. New insights into erythropoiesis: the roles of folate, vitamin B12, and iron. Annu Rev Nutr. 2004;24:105–31.

    Article  CAS  Google Scholar 

  34. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington, DC: National Academy Press. 1998, p. 306–356, http://www.nap.edu/catalog/6015.html.

  35. Oosterhuis WP, et al. Diagnostic value of the mean corpuscular volume in the detection of vitamin B12 deficiency. Scand J Clin Lab Invest. 2000;60(1):9–18.

    Article  CAS  Google Scholar 

  36. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149–60.

    Article  CAS  Google Scholar 

  37. Devalia V, et al. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496–513.

    Article  CAS  Google Scholar 

  38. Oberley MJ, Yang DT. Laboratory testing for cobalamin deficiency in megaloblastic anemia. Am J Hematol. 2013;88(6):522–6.

    Article  CAS  Google Scholar 

  39. Randhawa J, et al. What should I know before ordering a bone marrow aspiration/biopsy in patients with vitamin B12 deficiency? BMJ Case Rep. 2013;2013:bcr2013010200.

    Article  Google Scholar 

  40. Chintagumpala MM, Dreyer ZA, Steuber CP, et al. Pancytopenia with chromosomal fragility: vitamin B12 deficiency. J Pediatr Hematol Oncol. 2013;1996:166–70.

    Google Scholar 

  41. Heath CW Jr. Cytogenetic observations in vitamin B12 and folate deficiency. Blood. 1966;27(6):800–15.

    Article  CAS  Google Scholar 

  42. Langan RC, Goodbred AJ. Vitamin B12 deficiency: recognition and management. Am Fam Physician. 2017;96(6):384–9.

    PubMed  Google Scholar 

  43. Mechanick JI, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer Davila .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Davila, J., Velez-Yanguas, M.C. (2020). Vitamin B12 Deficiency. In: Srivaths, L. (eds) Hematology in the Adolescent Female. Springer, Cham. https://doi.org/10.1007/978-3-030-48446-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-48446-0_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48445-3

  • Online ISBN: 978-3-030-48446-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics