Vitamin B 12 deficiency: NICE guideline summary Linked Editorial The persistent challenge of diagnosing and treating vitamin B12 deficiency Toby Sands, technical analyst1, Aamer Jawed, technical analyst1, Emma Stevenson, principal clinical biochemist2, Maddie Smith, patient author3, Imran Jawaid, portfolio general practitioner, chair of guideline committee, clinical assessment lead and associate professor4 on behalf of the Guideline Committee 1 National Institute for Health and Care Excellence, Manchester, UK 2 Clinical Biochemistry, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK 3 Patient author 4 The University of Buckingham, Buckinghamshire, UK Correspondence to: T Sands Toby nice.org.uk What you need to know Offer an initial diagnostic test (total or active B 12 ) for suspected deficiency to people who have at least one common symptom or sign and at least one common risk factor for the condition Consider a further test to measure serum methylmalonic acid concentrations in people who have symptoms or signs of vitamin B 12 deficiency and an indeterminate total or active B 12 test result When offering oral vitamin B 12 replacement to people with vitamin B 12 deficiency caused, or suspected to be caused, by malabsorption, prescribe a dosage of at least 1 mg a day Vitamin B 12 deficiency is associated with a range of symptoms and signs, resulting in substantial variation in patient presentation
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