Folic acid is also called folate. It is another B vitamin. Either a lack of vitamin B-12 or a lack
of folate causes a type of anemia called megaloblastic anemia (pernicious anemia). With
these types of anemia, the red blood cells don’t develop normally. They are very large. And
they are shaped like an oval. Healthy red blood cells are round. This causes the bone
marrow to make fewer red blood cells. In some cases, the red blood cells die sooner than
normal.
Lack of intrinsic factor. Intrinsic factor is a protein made in the stomach. It is needed to
absorb vitamin B-12. This type of B-12de ciency anemia is called pernicious anemia.
Inability to absorb vitamin B-12. Surgery that removes or bypasses the end of the
small intestine may be one reason that B-12 can't be absorbed. Other causes include
changes in the small bowel that limit how much vitamin B-12 you can absorb.
The inability to make intrinsic factor may be caused by several things, such as:
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Chronic gastritis
Other types of megaloblastic anemia may be linked to type 1 diabetes, thyroid disease, and
a family history of the disease.
Crohn's disease
HIV
Some medicines
Weak muscles
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3/12/2019 Vitamin B-12 Deficiency Anemia - Health Encyclopedia - University of Rochester Medical Center
Trouble walking
Nausea
Decreased appetite
Weight loss
Irritability
Diarrhea
The symptoms of vitamin B-12 anemia may look like other blood conditions or health
problems. Always see your healthcare provider for a diagnosis.
You may also need other blood tests. You may also have other assessment procedures,
such as a bone marrow biopsy.
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3/12/2019 Vitamin B-12 Deficiency Anemia - Health Encyclopedia - University of Rochester Medical Center
Vitamin B-12 de ciency anemia and folate de ciency anemia often occur together and can
be hard to tell apart. Treatment may include vitamin B-12 shots (injections) or folic acid
pills.
Orange juice
Oranges
Romaine lettuce
Spinach
Liver
Rice
Barley
Sprouts
Wheat germ
Soy beans
Leafy gr vegetables
Beans
Peanuts
Broccoli
Asparagus
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3/12/2019 Vitamin B-12 Deficiency Anemia - Health Encyclopedia - University of Rochester Medical Center
Peas
Lentils
Foods that are rich in both folic acid and vitamin B-12 include:
Eggs
Meat
Poultry
Milk
Shell sh
Forti ed cereals
Taking folic acid by mouth works better than eating foods rich in folic acid. Vitamin B-12 is
not as well absorbed by mouth as by injection.
If your de ciency is from a restrictive diet, you may want to work with a nutritionist. He or
she can help ensure that you get enough vitamin B-12 and other vitamins. Tell your
healthcare provider about any symptoms and follow your treatment plan.
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3/12/2019 Vitamin B-12 Deficiency Anemia - Health Encyclopedia - University of Rochester Medical Center
With this condition, your body does not have enough healthy red blood cells because of
a lack (de ciency) of vitamin B
Without enough red blood cells, your tissues and organs don’t get enough oxygen.
Without enough oxygen, your body can’t work as well.
Symptoms include weak muscles, numbness, trouble walking, nausea, weight loss,
irritability, fatigue, and increased heart rate.
Treatment may include vitamin B-12 supplements. It is also important to eat a well-
balanced diet.
Next steps
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Bring someone with you to help you ask questions and remember what your provider
tells you.
At the visit, write down the name of a new diagnosis, and any new medicines,
treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side e ects are.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
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3/12/2019 Vitamin B-12 Deficiency Anemia - Health Encyclopedia - University of Rochester Medical Center
If you have a follow-up appointment, write down the date, time, and purpose for that
visit.
Know how you can contact your provider if you have questions.
Medical Reviewers:
Richard LoCicero MD
Make an Appointment
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