When should I refer a person with vitamin B12 or folate deficiency anaemia?
• Seek urgent advice from a haematologist if the person has neurological symptoms or is pregnant. • Refer to a haematologist if the cause of vitamin B12 or folate deficiency is uncertain following investigations, or the suspected cause is haematological malignancy (urgently refer) or other blood disorder. • Refer to a gastroenterologist if: • Malabsorption of vitamin B12 (other than pernicious anaemia) or folate is suspected. • The person has pernicious anaemia and gastrointestinal symptoms, especially if there is a suspicion of gastric cancer (e.g. co-existing iron deficiency). The urgency of referral will depend on the nature of the symptoms. • The person is folate deficient, and antibody testing suggests coeliac disease (positive for anti-endomysial or anti-transglutaminase antibodies). • Consider referral to a dietitian if vitamin B12 or folate deficiency is thought to be due to a poor diet.
