Abstract
Background: Vitamin B12 deficiency is common in primary care but its treatment practices vary across centres. One important cause of B12 deficiency is pernicious anaemia (identified by intrinsic factor antibodies), which is a risk factor for developing gastric carcinoma, and should be excluded. Additionally, recent evidence has suggested that some patients have been continued on B12 injections with no clear clinical indication. Recently,guidelines were produced to improve the investigation and management of B12 deficiency. Hence, this audit studied the investigation and management of B12 deficiency and adherence to clinical guidelines in a general practice (GP) in north-west England.Aim: To evaluate the appropriate diagnosis and management of vitamin B12 deficiency in our primary care centre against recognized standards.Methods: Clinical data of patients currently on oral cyanocobalamin and/or intramuscular hydroxocobalamin injections over a 1-year period were audited.Results: Thirty-eight patients (66% females, 34% males) receiving treatment for B12 deficiency were identified. Of these, 55% (21/38) had intrinsic factor antibodies checked and 52% (13/25) were managed according to the guidelines. 100% (8/8) of patients with dietary B12 deficiency (non-vegans) and 75% (3/4) of B12-deficient patients on long-term metformin have had follow-up serum B12 monitoring.Discussion: There is a need to improve the investigation for B12 deficiency, adherence to clinical guidelines, and documentation of patients’ diagnoses, treatment plans, dietary statuses, and required monitoring. We anticipate that adhering to guidelines when appropriate, with clear documentation, will improve the diagnosis and management of vitamin B12 deficiency so that safe prescribing and potential cost savings can be achieved.
Highlights
Vitamin B12 deficiency is commonly encountered in primary care, among the elderly.[1]
A total of 38 patients (66% female, 34% male) on B12 replacement were identified, of which 4 (11%) presented with neurological symptoms associated with B12 deficiency whereas the remaining 34 patients (89%) did not present with any neurological features
All patients who had tested positive for intrinsic factor antibodies (IFA) did not need to be referred to the appropriate specialists for further evaluation as they were clinically stable and responsive to vitamin B12 replacement
Summary
Vitamin B12 deficiency is commonly encountered in primary care, among the elderly.[1]. The Manchester Anaemia Guide[3] was published, with reference to the NICE Clinical Knowledge Summaries (CKS),[4] to provide clinical guidance on these issues It emphasised that, as part of the diagnostic process for every patient with suspected B12 deficiency, pernicious anaemia (PA), should be excluded by checking for intrinsic factor antibodies, as affected patients have an increased risk of developing gastric carcinoma.[5] PA is associated with many other autoimmune conditions (e.g. Graves’ disease and vitiligo).[6] identifying these patients would inform the need for further work-up or referral to a specialist for evaluation in the presence of any significant clinical finding that suggests an underlying gastric carcinoma or autoimmune condition. This audit studied the investigation and management of B12 deficiency and adherence to clinical guidelines in a general practice (GP) in north-west England
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