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Samwel Mikaye: Key Insights on Vitamin B12 Deficiency
Dr. S.0 MIKAYE / LinkedIn
May 7, 2026, 15:38

Samwel Mikaye: Key Insights on Vitamin B12 Deficiency

Samwel Mikaye, Medical Doctor at MSK, shared a post on LinkedIn:

“Vitamin B12 deficiency is a condition where the body lacks enough vitamin B12 (cobalamin), leading to problems in red blood cell formation and nervous system function.

Causes

Reduced intake

  • Strict vegan diet (no animal products)
  • Malnutrition

Malabsorption

  • Pernicious anemia (most important cause)
  • Gastrectomy or bariatric surgery
  • Diseases of terminal ileum (e.g. Crohn’s disease)
  • Chronic alcoholism

Others

  • Long-term metformin use
  • Proton pump inhibitors (reduce acid leading to less absorption)

Pathophysiology

  • Impaired DNA synthesis leads to megaloblastic anemia
  • Accumulation of methylmalonic acid leads to nerve damage

Clinical features

Hematological

  • Fatigue, pallor
  • Shortness of breath
  • Megaloblastic anemia

Neurological (key distinguishing feature)

  • Peripheral neuropathy (tingling, numbness)
  • Loss of vibration and position sense
  • Ataxia (unsteady gait)
  • Cognitive changes

Severe untreated cases lead to irreversible nerve damage

Others

  • Glossitis (smooth, beefy red tongue)
  • Mild jaundice

Investigations

  • Serum vitamin B12 low
  • CBC indicates macrocytic anemia (high MCV)
  • Blood film shows hypersegmented neutrophils
  • High methylmalonic acid (specific for B12 deficiency)
  • High homocysteine

Differentiate from folate deficiency

  • Both cause megaloblastic anemia
  • Only B12 causes neurological symptoms

Management

Replacement therapy

  • Hydroxocobalamin (preferred IM)
  • Frequent doses initially, then maintenance
  • Oral B12 if mild and absorption intact

Important rule

Never give folate alone if B12 deficiency is possible, it may worsen neurological damage.

Prevention

  • Adequate diet (meat, eggs, dairy)
  • Supplementation in vegans
  • Monitor high-risk patients (elderly, post-surgery)”

Samwel Mikaye

Other posts featuring Samwel Mikaye on Hemostasis Today.

ataxia Bariatric Surgery Blood CBC cobalamin Crohn's Disease Gastrectomy Glossitis Health Hematology Hemostasis Hemostasis News Hemostasis Today Hydroxocobalamin Hypersegmented Neutrophils Macrocytic Anemia MCV Medicine Megaloblastic Anemia Metformin methylmalonic acid Mild jaundice Nervous system Pernicious Anemia Red Blood Cell Samwel Mikaye Vitamin B12 Vitamin B12 Deficiency
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