Intended for healthcare professionals

Letters Pernicious anaemia

Pernicious anaemia: switch to oral B12 supplementation to reduce risk of covid-19 transmission

BMJ 2020; 369 doi: (Published 17 June 2020) Cite this as: BMJ 2020;369:m2383
  1. Amrit Takhar, general practitioner
  1. Wansford and Kings Cliffe Practice, Wansford PE8 6PL, UK
  1. amrit.takhar{at}

Mohamed and colleagues’ review of current practice in pernicious anaemia acknowledges the evidence for oral supplementation.1 In my own general practice, we have offered patients the choice of oral or injection therapy since 2007 and have found that most patients prefer an oral route for both convenience and avoidance of a painful injection.

Studies in the 1950s and 60s showed that oral vitamin B12 could be absorbed by patients with pernicious anaemia and could lead to resolution of the anaemia.23 Passive diffusion of B12, in the absence of intrinsic factor, accounts for about 1% of total absorption, and this route is unaffected in patients with pernicious anaemia, but high doses are needed for it to be effective.

With current covid-19 social distancing guidelines, now is an ideal time to switch patients receiving injections every three months to oral supplements, saving nurse appointments and reducing the risk of covid-19 transmission.


  • Competing interests: None declared.

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