This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Referral criteria from primary care - vitamin B12 deficiency

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Seek urgent advice from a haematologist if:

  • the patient is pregnant
  • if functional B12 deficiency is suspected i.e. strong clinical features of B12 deficiency, e.g. megaloblastic anaemia or subacute combined degeneration of the cord, despite normal vitamin B12 (1)
  • if pancytopenia then seek urgent advice from a haematologist (2)
  • haematological malignancy or other blood disorder is suspected - refer urgently using a suspected cancer pathway referral

Non urgent haematology referral/seeking expert haematologist advice:

  • following investigations the cause of vitamin B12 or folate deficiency is unclear or uncertain (2)
  • non-response to vitamin B12 treatment.
  • mean cell volume is persistently greater than 105 femtolitres (4)

Consider seeking urgent advice from a neurologist if:

  • neurological symptoms are present

Refer to a gastroenterologist if:

  • malabsorption is suspected or if there is a suspicion of gastric cancer or coeliac disease
  • gastroscopy is recommended initially in patients diagnosed with pernicious anaemia for the diagnosis of atrophic gastritis and for evaluation of gastric malignancies (3)
    • if pernicious anaemia and gastrointestinal symptoms - particularly if there is a suspicion of gastric cancer (for example co-existing iron deficiency)
      • if there is a suspicion of gastric cancer then refer urgently using a suspected cancer pathway referral

Consider referral to a dietician if B12 deficiency is due to poor diet.


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.