# Vitamin B12 Deficiency Anaemia - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 for the schedule, with the dose from Egyptian National Drug Formulary - Blood disorders 2025, hydroxocobalamin monograph (endf-blood-2025.txt): "Addisonian pernicious anemia and other macrocytic anemias with neurological involvement Initial: IM: 1 mg every other day for as long as there is improvement. Maintenance: IM: 1mg every 2 months." The formulary's maintenance interval is 2 to 3 months against the 3 months used here. · BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 - Verified date: 2026-08 ## Verified against - BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 for the schedule, with the dose from Egyptian National Drug Formulary - Blood disorders 2025, hydroxocobalamin monograph (endf-blood-2025.txt): "Addisonian pernicious anemia and other macrocytic anemias with neurological involvement Initial: IM: 1 mg every other day for as long as there is improvement. Maintenance: IM: 1mg every 2 months." The formulary's maintenance interval is 2 to 3 months against the 3 months used here. - BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 ## Treatment metadata - Hydroxocobalamin — 1 mg — injection - Cyanocobalamin — 1 mg — oral.solid ## Complete treatment card ```text VITAMIN B12 DEFICIENCY ANAEMIA Sources: BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 for the schedule, with the dose from Egyptian National Drug Formulary - Blood disorders 2025, hydroxocobalamin monograph (endf-blood-2025.txt): "Addisonian pernicious anemia and other macrocytic anemias with neurological involvement Initial: IM: 1 mg every other day for as long as there is improvement. Maintenance: IM: 1mg every 2 months." The formulary's maintenance interval is 2 to 3 months against the 3 months used here. · BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination RED FLAGS (2) - Left untreated the neurological damage becomes severe and disabling, and may not fully recover - Do not give folic acid with, or instead of, B12 when B12 deficiency is suspected - folate masks the anaemia while the neurological damage continues SYMPTOMS - what the patient reports (4) - Fatigue and pallor from macrocytic anaemia are the usual presenting symptoms [anaemia · fatigue · pallor] - Jaundice can be a presenting symptom, from the increased haemolysis of poorly formed red cells [haemolysis · jaundice] - Other presenting complaints are peripheral neuropathy, glossitis, diarrhoea, headache and neuropsychiatric disturbance [diarrhoea · headache] - Ask about gastrectomy, gastric bypass or ileal resection, Crohn or coeliac disease, and a strict vegan diet kept for about 3 years SIGNS - what you find (2) - A full neurological examination should look for dementia, peripheral neuropathy, unsteadiness and loss of proprioception [unsteadiness] - Subacute combined degeneration affects the dorsal columns, the lateral corticospinal tracts and the spinocerebellar tracts TESTS (7) - Start with a full blood count and film, plus serum B12 and serum folate together - Serum B12 above 300 pg/mL is normal, 200 to 300 borderline, below 200 deficient - MCV above 100 with a fall in haemoglobin and haematocrit; the film shows hypersegmented neutrophils with 5 or more lobes - For a borderline B12, methylmalonic acid and homocysteine are both raised in B12 deficiency - In folate deficiency homocysteine rises but methylmalonic acid stays normal - that is how the two separate - Anti-intrinsic-factor antibodies diagnose pernicious anaemia once surgical, gastrointestinal and dietary causes are excluded - A low serum B12 does not name the cause; the cause still has to be worked out IF NOT THIS - what else fits (4) - Folate deficiency also gives a macrocytic anaemia and is the commonest confusion - Lead toxicity, syphilis, HIV myelopathy and multiple sclerosis - Causes: pernicious anaemia, gastrectomy or gastric bypass, ileal resection, Crohn, coeliac, Diphyllobothrium latum, strict vegan diet, metformin, nitrous oxide - Among patients with an MCV over 100, 18% to 20% are due to B12 deficiency Source StatPearls "Vitamin B12 Deficiency" (NBK441923) - disease-level clinical article; the folate-masking warning is from StatPearls "Vitamin B12 (Cobalamin)" (NBK559132) Status traced to the source above 1. HYDROXOCOBALAMIN [1st line] Adult 1 mg IM 3 times a week for 2 weeks (without neurological symptoms), then 1 mg IM every 3 months for life - lifelong maintenance Peds 1 mg IM on alternate days until improvement, then 1 mg IM every 2-3 months Source BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 for the schedule, with the dose from Egyptian National Drug Formulary - Blood disorders 2025, hydroxocobalamin monograph (endf-blood-2025.txt): "Addisonian pernicious anemia and other macrocytic anemias with neurological involvement Initial: IM: 1 mg every other day for as long as there is improvement. Maintenance: IM: 1mg every 2 months." The formulary's maintenance interval is 2 to 3 months against the 3 months used here. Why Hydroxocobalamin given intramuscularly is the preferred formulation. The BSH 2014 guideline states it as practice rather than as a comparison: "Current clinical practice within the UK is to treat cobalamin deficiency with hydroxocobalamin in the intramuscular form." Caution IF NEUROLOGICAL SYMPTOMS PRESENT (paresthesias, ataxia, subacute combined degeneration): Give 1 mg IM on alternate days until no further improvement, then 1 mg every 2 months. There is a hypokalemia risk: monitor serum potassium during the initial phase of rapid reticulocytosis. Check folate levels — giving folate alone in B12 deficiency precipitates severe irreversible subacute combined degeneration of spinal cord. Egypt DEPOLVIX B12 1MG/ML 2 I.M. AMP. SIGMA TEC 10.50 EGP NEW ECAVIT B12 1MG/2ML 6 AMP. I.M EL NILE. 19.50 EGP B12 DEPOT 1000 MCG 5 AMP. ARAB DRUG COM... 26.25 EGP LONGAVIT B12 1MG/ML 3 AMP. FOR IM INJ. MEMPHIS 36.00 EGP DEPOVIT B12-1000MCG/ML 3 I.M. AMPS. AMRIYA 51.00 EGP COBALAMIN DEPOT 1000MCG/ML 5 I.M. AMP. PHAROPHARMA 55.00 EGP DEPOFORT B12 1MG/ML 5 AMP. PHARCO 55.00 EGP DEPOVIT B12-1000MCG/ML 5 I.M. AMPS. AMRIYA 85.00 EGP 2. CYANOCOBALAMIN [2nd line] Adult 1000-2000 mcg (1-2 mg) orally once daily - long-term Peds 50-100 mcg daily orally for dietary deficiency Source BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 Why High-dose oral cyanocobalamin alternative for dietary B12 deficiency (vegans) or when IM injection is refused Caution The oral route is unreliable in severe pernicious anaemia or ileal resection. Requires compliance with high daily oral dose. Egypt B12 SR 1000MCG 20 CAPS. INTERNATIONAL... 30.00 EGP (1.50/unit) LIPOSOM-B12 1000 MCG 20 SUBLINGUAL TABS. HOCHSTER PHARMACEUTICAL INDUSTRIES 60.00 EGP DELTAVIT B12 - 1 MG 30 SUBLINGUAL TABS. DELTA PHARMA 75.00 EGP DEVART B12 1000 MCG 30 SUBLINGUAL TABS DEVARTLAB > BIOERA 80.00 EGP LIPOSOM-B12 1000 MCG 30 SUBLINGUAL TABS. HOCHSTER PHARMACEUTICAL INDUSTRIES 90.00 EGP JOVEMED B12 - 1000 MCG 30 SUBLINGUAL TABS. MEDIZEN PHARMACEUTICAL INDUST... 120.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)