What follow-up measures should I implement for patients treated for vitamin B12 deficiency to ensure effective management and prevent recurrence?

Implement follow-up measures for patients treated for vitamin B12 deficiency by scheduling an initial follow-up appointment at 3 months after starting treatment, or earlier if symptoms are severe, or at 1 month if pregnant or breastfeeding ¹.

At each follow-up, ask the patient if their symptoms have improved, worsened, or if they have new symptoms related to vitamin B12 deficiency ¹.

For patients on oral vitamin B12 replacement, check they are taking the correct dosage and consider increasing the dose to the maximum licensed dosage if symptoms persist or worsen ⁴.

If symptoms have not improved sufficiently, or if they worsen or new symptoms develop, consider increasing injection frequency, exploring alternative diagnoses, and agree on a reassessment date ⁴.

For patients with an irreversible cause of deficiency, continue lifelong intramuscular injections and advise them to return if symptoms recur or worsen ¹, ², ³, ⁴.

If the cause of deficiency has been addressed and symptoms have improved or resolved, consider stopping or reducing injection frequency, and advise the patient to return if symptoms reappear or worsen ¹, ², ³, ⁴.

Measure serum methylmalonic acid (MMA) or plasma homocysteine if symptoms persist or worsen, to explore ongoing deficiency or alternative diagnoses ¹, ², ³, ⁴.