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Vitamin B-12 deficiency

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c2305 (Published 1 June 2010)
Cite this as: BMJ 2010;340:c2305

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  1. Ben Hudson, senior lecturer
  1. 1Department of Public Health and General Practice, University of Otago, Christchurch 8140, New Zealand
  1. Correspondence to: ben.hudson{at}otago.ac.nz
  • Accepted 19 April 2010

An 85 year old man had a preoperative assessment for a knee replacement. His full blood count was normal apart from haemoglobin 95 g/l and mean corpuscular volume 105 fl. He drank no alcohol. Further testing showed that his vitamin B-12 was low: 90 pmol/l (reference range 160-800 pmol/l). Folate, ferritin, thyroid stimulating hormone, and liver function tests were normal. He had no other medical or surgical history and ate a balanced diet that includes meat.

Vitamin B-12 is found only in foods of animal origin. Dietary B-12 is freed from food protein by pepsin in the acid gastric environment and binds to haptocorrin, a protein secreted in saliva. In the small intestine, haptocorrin is degraded by pancreatic enzymes; vitamin B-12 is released and binds with intrinsic factor, which is secreted by gastric parietal cells. This complex binds to receptors at the terminal ileum and is actively absorbed. A small fraction (1-2%) of the intake of B-12 is passively absorbed …

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