Monitoring
Patients with vitamin B12 deficiency should have close follow-up to confirm the diagnosis and to determine response to treatment. In patients with minimal symptoms and without anaemia causing haemodynamic compromise, this can generally be done 2 to 3 months from initiation of treatment. Follow-up serum vitamin B12 levels, methylmalonic acid levels, or homocysteine levels should be measured to determine response to treatment.
European Society for Clinical Nutrition and Metabolism guidelines recommend a minimum of annual assessment for individuals at risk of vitamin B12 deficiency or those receiving treatment.[59]
Incomplete response should alert the clinician to look for other causes of macrocytic anaemia and/or neurological disease.
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