Diagnosis

Doctors diagnose vitamin deficiency anemias through blood tests that check:

  • The number and appearance of red blood cells. People with anemia have fewer red blood cells than normal. In vitamin deficiency anemias related to a lack of vitamin B-12 and folate, the red blood cells appear large and underdeveloped. In advanced deficiencies, the numbers of white blood cells and platelets also might be decreased and look abnormal under a microscope.
  • The amount of folate, vitamin B-12 and vitamin C in your blood. Folate and vitamin B-12 levels are measured at the same time because these deficiencies can cause similar signs and symptoms.

Additional tests for B-12 deficiency

If blood tests reveal a vitamin deficiency, your doctor may perform other tests to determine the type and cause, such as:

  • Antibodies test. Your doctor may draw a sample of your blood to check for antibodies to intrinsic factor. Their presence indicates pernicious anemia.
  • Methylmalonic acid test. You may undergo a blood test to measure the presence of a substance called methylmalonic acid. The level of this substance is higher in people with vitamin B-12 deficiency.
  • Schilling test. In this test, you first ingest a tiny amount of radioactive vitamin B-12. Then your blood is checked to see if your body absorbed the vitamin B-12. After that, you ingest a combination of radioactive vitamin B-12 and intrinsic factor. If the radioactive B-12 is absorbed only when taken with intrinsic factor, it confirms that you lack your own intrinsic factor.

Treatment

Treatment for vitamin deficiency anemia includes supplements and changes in diet.

  • Folate deficiency anemia. Treatment involves eating a healthy diet and taking folic acid supplements as prescribed by your doctor. In most cases, folic acid supplements are taken orally. Once your body's level of folate increases to normal, you may be able to stop taking the supplements. But if the cause of your folate deficiency can't be corrected, you may need to take folic acid supplements indefinitely.
  • Vitamin B-12 deficiency anemia, including pernicious anemia. For milder cases of vitamin B-12 deficiency, treatment may involve changes to your diet and vitamin B-12 supplements in pill form or as a nasal spray. Your doctor may suggest vitamin B-12 injections, particularly if your vitamin B-12 deficiency is severe. At first, you may receive the shots as often as every other day. Eventually, you'll need injections just once a month, which may continue for life, depending on your situation.
  • Vitamin C deficiency anemia. Treatment for anemia related to vitamin C deficiency is with vitamin C tablets. Additionally, you increase your intake of foods and beverages that contain vitamin C.

Preparing for your appointment

If you suspect that you have vitamin deficiency anemia, you're likely to start by seeing your family doctor or a general practitioner. However, in some cases, you may be referred to a doctor who specializes in treating blood disorders (hematologist).

Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications as well as any vitamins or supplements you're taking.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. For vitamin deficiency anemia, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • Could anything else be causing my symptoms?
  • Is my condition likely temporary or long lasting?
  • What treatment do you recommend?
  • Are there any alternatives to the approach that you're suggesting?
  • I have another health condition. How can I best manage these conditions together?
  • Are there any foods I need to add to my diet?
  • Are there any brochures or other material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment anytime that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

  • When did you begin experiencing symptoms?
  • How severe are your symptoms?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Are you a vegetarian?
  • How many servings of fruits and vegetables do you usually eat in a day?
  • Do you drink alcohol? If so, how often, and how many drinks do you usually have?
  • Are you a smoker?
Nov. 09, 2016
References
  1. Kaushansky K, et al. Folate, cobalamin, and megaloblastic anemias. In: Williams Hematology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2016. http://accessmedicine.mhmedical.com/content.aspx?sectionid=101237678&bookid=1581&Resultclick=2#1121092138. Accessed Oct. 10, 2016.
  2. Schrier SL, et al. Etiology and clinical manifestations of vitamin B12 and folate deficiency. http://www.uptodate.com/home. Accessed Oct. 10, 2016.
  3. 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://health.gov/dietaryguidelines/2015/guidelines/.  Accessed Oct. 10, 2016.
  4. Goldman L, et al., eds. Approach to the anemias. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Sept. 18, 2016.
  5. Pazirandeh S, et al. Overview of water-soluble vitamins. http://www.uptodate.com/home. Accessed Oct. 10, 2016.
  6. Vitamin C: Fact sheet for health professionals. National Institutes of Health Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/.  Accessed Oct. 10, 2016.
  7. Schrier SL. Diagnosis and treatment of vitamin B12 and folate deficiency. http://www.uptodate.com/home. Accessed Oct. 10, 2016.
  8. Walker BR, et al. Environmental and nutritional factors in disease. In: Davidson's Principles and Practice of Medicine. 22nd ed. London, England: Churchill Livingston Elsevier; 2014. http://www.clinicalkey.com.
  9. Folate: Fact sheet for health professionals. National Institutes of Health Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/.  Accessed Oct. 10, 2016.
  10. Alcohol and public health: Frequently asked questions. Centers for Disease Control and Prevention. http://www.cdc.gov/alcohol/faqs.htm. Accessed Oct. 10, 2016.
  11. Mesa RA (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 17, 2016.