The video version of this podcast can be found here: https://youtu.be/0cD2zityw9IThe interactive flowchart can be accessed here:https://1drv.ms/b/s!AiVFJ_Uoigq0mRYQ2Yw67rtg00TM?e=2DpSYIThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through the recently published NICE guideline on vitamin B12 deficiency in adults, focusing on those that are relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Apple podcast: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148· Spotify: https://open.spotify.com/show/2kmGZkt1ssZ9Ei8n8mMaE0?si=9d30d1993449494e· Amazon Music: https://music.amazon.co.uk/podcasts/0edb5fd8-affb-4c5a-9a6d-6962c1b7f0a1/primary-care-guidelines?ref=dm_sh_NnjF2h4UuQxyX0X3Lb3WQtR5P· Google Podcast: https://www.google.com/podcasts?feed=aHR0cHM6Ly9mZWVkcy5yZWRjaXJjbGUuY29tLzI1ODdhZDc4LTc3MzAtNDhmNi04OTRlLWYxZjQxNzhlMzdjMw%3D%3D· Redcircle: https://redcircle.com/shows/2587ad78-7730-48f6-894e-f1f4178e37c3 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE guideline “Vitamin B12 deficiency in over 16s: diagnosis and management” (NICE guideline NG239 can be found here:· https://www.nice.org.uk/guidance/ng239The links to the resource “Oral vitamin B12 replacement: ongoing care and follow up” can be found here:· https://www.nice.org.uk/guidance/ng239/resources/visual-summary-ongoing-care-and-followup-for-vitamin-b12-replacement-pdf-13315996909The B12 pandemic guidance by the British Society of Haematology can be found here:· https://apps.nhslothian.scot/refhelp/guidelines/haematology/b12deficiency/Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE guideline on vitamin B12 deficiency in adults, published as recently as March 2024, focusing on what is relevant in Primary Care only. Make sure to stay for the entire episode because, at the end, I will tell you how to access an interactive flowchart that I have created and that summarises the guidance.Right, so let’s jump into it. Let’s start by looking at common symptoms and signs of vitamin B12 deficiency, which are:· anaemia or macrocytosis on a FBC, but we should not rule out a diagnosis of vitamin B12 deficiency based solely on the absence of either anaemia or macrocytosis· difficulty concentrating or short-term memory loss, also sometimes described as 'brain fog'· glossitis and mouth ulcers· unexplained fatigue· eyesight problems related to optic nerve dysfunction likeo blurred visiono a visual field loss or scotoma ando optic atrophy signs on fundoscopy · neurological or mobility problems including o balance issues and falls due to impaired proprioception or sensory ataxia o impaired gait ando paraesthesia, and finally· it can also be associated with mental health problems, including symptoms of depression, anxiety or psychosis.There are also common risk factors for vitamin B12 deficiency. Before looking at them, let’s briefly look at the physiology of vit B12 in the human body.In food, vitamin B-12 is generally bound to protein, so in the stomach, gastric enzymes such as pepsin separate the vitamin B12 from the protein using. Then, the freed vitamin B12 then combines with a protein produced by parietal cells in the stomach, called intrinsic factor. The vitamin B12-IF complex is taken to the cells in the terminal ileum, where the vitamin B12 is absorbed. So, in summary, for vit B12 to be absorbed effectively, we need a sufficient dietary intake and normal physiological processes in the stomach and terminal ileum. So, with that in mind, the common risk factors for vitamin B12 deficiency are:·...
