Treatment of Vitamin B12–Deficiency Anemia: Oral versus Parenteral Therapy

@article{Lane2002TreatmentOV,
  title={Treatment of Vitamin B12–Deficiency Anemia: Oral versus Parenteral Therapy},
  author={Lenee A Lane and Carlos H. Rojas-Fernandez},
  journal={Annals of Pharmacotherapy},
  year={2002},
  volume={36},
  pages={1268 - 1272}
}
OBJECTIVE: To evaluate the use of oral cyanocobalamin therapy in the treatment of cobalamin (vitamin B12)–deficient anemia. DATA SOURCES: Primary and review articles were identified by MEDLINE search (1966–May 2000) and through secondary sources. DATA SYNTHESIS: Cobalamin-deficient anemia is among the most common diagnoses in older populations. Cobalamin-deficient anemia may be diagnosed as pernicious anemia, resulting from the lack of intrinsic factor required for cobalamin absorption or as… 
Oral cobalamin (vitamin B12) treatment. An update
TLDR
This present review confirms the previously reported efficacy of oral cobalamin treatment in adult and elderly patients and confirms that at least 1000 μg/day of oral cyanocobalmin are needed for pernicious anemia and a mean daily dose of 250’μg for food‐cobalamin malabsorption.
Efficacy of short-term oral cobalamin therapy for the treatment of cobalamin deficiencies related to food-cobalamin malabsorption: a study of 30 patients.
TLDR
Crystalline cyanocobalamin, 250-1000 microg/day, given orally for 1 month, may be an effective treatment for cobalamin deficiencies not related to pernicious anemia.
Short-Term Oral Cobalamin Therapy for Food-Related Cobalamin Malabsorption
TLDR
It is suggested that patients with cobalamin deficiency related to FCM promptly benefit from oral crystalline cyanocobalamin treatment, and during the first month of therapy, most patients had significant improvement in serumcobalamin levels as well as in blood cell counts.
Update of Food-Cobalamin Malabsorption and Oral Cobalamin Therapy
Cobalamin (vitamin B12) deficiency is particularly common in the elderly (>65 years of age), but is often un- recognized because its clinical manifestations are subtle; however, they are also
Cobalamin Deficiency in Older Adults
TLDR
Oral cobalamin therapy is of particular interest in the management of food-cobalamin malabsorption syndrome, which is frequently associated with atrophic gas- tritis, and long-term ingestion of antacids and biguanides.
State of art of oral vitamin B12 (cobalamin) treatment in Biermer's disease (pernicious anemia)
TLDR
Evidence that oral vitamin B12 treatment may adequately treat cobalamin deficiency and Biermer’s disease is found and the efficacy was documented with a marked improvement in serum vitamin B 12 levels or normalization of this latter.
State of Art of Oral Vitamin B12 (Cobalamin) in Biermer’s Disease (Pernicious Anemia)
TLDR
There is evidence that oral vitamin B12 treatment may adequately treat cobalamin deficiency in patients presenting with severe neurological manifestations and the efficacy was particularly highlighted when looking at the marked improvement in serum vitamin B 12 levels and hematological parameters.
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References

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TLDR
In cobalamin deficiency, 2 mg of cyanocobalamin administered orally on a daily basis was as effective as 1 mg administered intramuscularly on a monthly basis and may be superior.
Age-Related Changes in Cobalamin (Vitamin B12) Handling
TLDR
Elderly patients respond to cobalamin treatment as fully as younger patients, with complete haematological recovery and complete or good partial resolution of neurological deficits, and should be treated if there is a metabolic deficiency (as indicated by elevated homocysteine and/or MMA levels).
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TLDR
It is concluded that the serum cobalamin is normal in a significant minority of patients with cobalamine deficiency and that the measurement of serum metabolite concentrations facilitates the identification of such patients.
NORMALIZATION OF LOW VITAMIN B12 SERUM LEVELS IN OLDER PEOPLE BY ORAL TREATMENT
TLDR
Serum gastrin levels are found to be higher in patients with protein-bound vitamin Blz malabsorption, a finding that supports the hypothesis of hypochlorhydria as an important pathophysiological mechani~m.
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TLDR
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  • Medicine
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TLDR
Four patterns of cobalamin deficiency are proposed; typical megaloblastic anemia with or without neurologic dysfunction occurs because of classical cobalamine malabsorption such as lack of intrinsic factor (pernicious anemia), and deficiency is both expressed subtly and arises from subtle or atypical causes.
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TLDR
Observations demonstrate that serum methylmalonic acid and total homocysteine levels are useful in diagnosing patients with cobalamin and folate deficiency and in distinguishing between these two vitamin deficiencies.
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TLDR
Experimental evidence obtained indicates that oral treatment with 500 μg of B12 daily has also resulted in replenishment of the B12 depots, and is a fully acceptable alternative to the conventional method of vitamin B12 injections.
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TLDR
Decisions about the optimal management of the very common problem of mild, preclinical cobalamin deficiency in the elderly await further clarification of the processes and the complex issues involved, including the possibility that routine nitrous oxide use during surgery, proposed dietary changes, and other practices may further stress the marginal cobalamina status of many elderly people.
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TLDR
It is a token of time that the same group of scientists, who launched the metabolites methylmalonic acid and homocysteine as markers for cellular deficiency of vitamin B12 a decade ago, now verified the efficiency of oral B12 treatment even for neurone lesions.
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