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Referral criteria from primary care - vitamin B12 deficiency

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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.

Reference:


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