Management of Low Vitamin B12 with Negative IFA and PCA Tests

Diagnostic Considerations

Topographical biopsies should be obtained to determine anatomic extent and histologic severity for risk stratification in patients with vitamin B12 deficiency, according to the American Gastroenterological Association 1
In patients with newly diagnosed pernicious anemia, upper endoscopy should be considered for risk stratification and to evaluate for prevalent gastric neoplasia and neuroendocrine tumors (NETs), as recommended by the American Gastroenterological Association 1

Surveillance endoscopy should be considered in patients with advanced atrophic gastritis every 3 years, and in patients with autoimmune gastritis at an interval based on individualized assessment, as suggested by the American Gastroenterological Association 1

Certain medications (colchicine, H2 receptor antagonists, metformin, phenobarbital, pregabalin, primidone) can contribute to vitamin B12 deficiency and should be evaluated as potential causes, according to the British Medical Journal 2