What follow-up is necessary after initiating treatment for B12 or folate deficiency anaemia to ensure resolution of the condition?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Offer an initial follow-up appointment at 3 months after starting treatment, or earlier depending on severity of symptoms, or at 1 month if pregnant or breastfeeding .

At each follow-up, ask the person if their symptoms have improved, worsened, or if they are experiencing new symptoms linked to vitamin B12 deficiency .

For people taking oral vitamin B12, check they are taking the correct dosage; if symptoms have not sufficiently improved, consider increasing the dose to the maximum licensed dosage or switching to intramuscular injections .

In cases of intramuscular treatment, do not repeat the initial diagnostic test; instead, monitor symptoms and consider further testing if symptoms worsen or new symptoms develop .

Assess for resolution of symptoms and consider stopping or reducing treatment if symptoms have resolved or improved and the cause has been addressed, with advice to return if symptoms reappear or worsen .

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