Comparison of the low-dose oral therapy results with literature and parenteral therapy in children with vitamin B12 deficiency




Vitamin B12 deficiency, Oral cyanocobalamin, Nutritional deficiency


Background: It was aimed to investigate the results of vitamin B12 deficiency treatment with a lower vitamin B12 loading dose and compare with literature.

Methods: Patients diagnosed with vitamin B12 deficiency at the pediatric hematology and oncology clinic between May 2017 and May 2018 were evaluated retrospectively. Patients who received a total of five doses of oral or parenteral cyanocobalamin treatment, 500 mcg two days a week in terms of region's socio-cultural status and accessibility to the health institution were included in the study. Vitamin B12 deficiency was defined as below 200 pg/ml. Post-treatment blood counts and vitamin B12 levels were reevaluated one month later after treatment was started. Vitamin B12 treatment responses were compared between the oral and parenteral groups and the results in the literature.

Results: Parenteral cyanocobalamin was used in 134 patients and oral cyanocobalamin was used in 146 patients. Post-treatment vitamin B12 values at first month were investigated in 115 and 123 children in parenteral and oral arms, respectively. A total of 238 patients were included in the study. Although control mean±standard deviation (SD) vitamin B12 values increased significantly in both groups. Compared to the literature, vitamin B12 mean±SD values (oral treatment group 349.48±179.12, parenteral treatment group 486.77±52.77) after treatment did not differ significantly according to higher doses and longer treatment.

Conclusions: In vitamin B12 deficiency, 500 mcg twice a week and a total of five dose oral cyanocobalamin is sufficient to increase the levels of vitamin B12.


Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299-326.

Honzik T, Adamovicova M, Smolka V, Magner M, Hruba E, Zeman J. Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency: what have we learned? Eur J Paediatr Neurol. 2010;14:488-95.

Strand TA, Taneja S, Ueland PM, Refsum H, Bahl R, Schneede J, et al. Cobalamin and folate status predicts mental development scores in North Indian children 12-18 mo of age. Am J Clin Nutr. 2013;97(2):310-7.

Wang H, Li L, Qin LL, Song Y, Vidal-Alaball J, Liu TH. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2018;3(3):CD004655.

Bolaman Z, Kadikoylu G, Yukselen V, Yavasoglu I, Barutca S, Senturk T. Oral versus intramuscular cobalamin treatment in megaloblastic anemia: a single-center, prospective, randomized, open-label study. Clin Ther. 2003;25:3124-34.

Castelli MC, Friedman K, Sherry J, Brazzillo K, Genoble L, Bhargava P, et al. Comparing the efficacy and tolerability of a new daily oral vitamin B12 formulation and intermittent intramuscular vitamin B12 in normalizing low cobalamin levels: a randomized, open-label, parallel-group study. Clin Ther. 2011;33(3):358-71.

Sanz-Cuesta T, González-Escobar P, Riesgo-Fuertes R, Garrido-Elustondo S, del Cura-González I, Martín-Fernández J, et al. Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12). BMC Public Health. 2012;12:394.

Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998;92:1191-8.

Roschitz B, Plecko B, Huemer M. Nutritional infantile vitamin B12 deficiency: pathobiochemical considerations in seven patients. Arch Dis Child Fetal Neonatal Ed. 2005;90:281-2.

Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003;67:979-86.

Vanderbrink BA, Cain MP, King S, Meldrum K, Kaefer M, Misseri R, et al. Is oral vitamin B12 therapy effective for vitamin B12 deficiency in patients with prior ileocytoplasty? J Urol. 2010;184:1781-5.

Sezer RG, Akoğlu HA, Bozaykut A, Özdemir GN. Comparison of the efficacy of parenteral and oral treatment for nutritional vitamin B12 deficiency in children. Hematology. 2018;23(9):653-7.

Bahadir A, Reis PG, Erduran E. Oral vitamin B12 treatment is effective for children with nutritional vitamin B12 deficiency. J Paediatr Child Health. 2014;50(9):721-5.

Sarbay H. Comparison of the severity of cytopenias with etiologic factors in patients with pancytopena and bicytopenia. Pan Afr Med J. 2019;34:149.

Lindenbaum J, Healton EB, Savage DG. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med. 1988;318:1720-8.

Whitehead VM, Rosenblatt DS, Cooper BA. Megaloblastic anemia. Hematology of Infancy and Childhood. In: Nathan DG, Oski FA, editors. Pediatrics haemotology. 6th edition. WB Saunders, Philadelphia. 2003;419-55.






Original Research Articles