The patient has a low serum B 12 and other metabolic abnormalities associated with Vitamin B 12 deficiency such as increased methylmalonic acid in serum or urine. The patient has a low serum B 12 and also has intrinsic factor antibody in serum. The patient is a long-standing strict vegetarian and has a low serum B 12 . If it is not possible to document true B 12 deficiency by checking the absorption of protein bound B 12 or checking the serum or urine methylmalonic acid, it is prudent to consider the case as early true B 12 deficiency and treat the patient with Vitamin B 12 . B 12 deficiency is a factor in the cause of neuro-psychiatric disorders.
Treatment consists of two stages, initial therapy and maintenance.
Proper diet will correct the deficiency. When serum B 12 is low but the patient shows no megaloblastic changes in blood or bone marrow and no neurological signs of B 12 deficiency. In a patient with megaloblastic anemia when both serum folate and serum B 12 are low. In B 12 deficiencies of children and young adults, when the possibilities of other forms of B 12 malabsorption due to congenital defects are higher. If improvement is questionable, consider performing the Schilling test to confirm underlying malabsorption.