Diagnosing Vitamin B12 Deficiency and Pernicious Anemia: Top 10 Tests

If you feel fatigued, and suspect B12 deficiency, then see your doctor immediately. Before diagnosing vitamin B12 deficiency or pernicious anemia, your doctor will run a vitamin B12 blood test for vitamin B12 levels in your blood, in addition to measuring your red blood cells and homocysteine levels. Here are ten tests still used today to diagnose vitamin B12 and pernicious anemia.

Vitamin B12 deficiency symptoms:

Vitamin B12 deficiency can be difficult to catch, because it masks itself as many other conditions. Sometimes, B12 deficiency occurs as a secondary side effect of a primary illness like fibromyalgia, Crohn’s disease, or celiac disease. Other times, vitamin B12 deficiency symptoms are overlooked because of underlying conditions such as depression or diabetes.

The most common symptoms of vitamin B12 deficiency and pernicious anemia are:

Constant fatigue that is not relieved by sleep and does not result from overexertion
Depression, long-term
Anxiety
Aggressive behavior that is unusual
Paranoia
Difficulty focusing or paying attention
Memory loss
Frequent forgetfulness
“Brain fog”
Forgetting words on “tip of tongue”
Forgetting numerical codes like phone numbers or PINs
Hallucinations
Painful tingling and numbness in extremities (hands, feet, arms, and legs)
“Pins and needles”
Painful tingling or burning sensation in tongue and mouth
Red, swollen tongue
Altered taste perception
Decreased balance and muscular coordination
Frequent stumbling and dropping things
Diarrhea
Sleep difficulties

What are the Symptoms of Pernicious Anemia- B12 deficiency?

10 Tests that diagnose vitamin B12 deficiency and pernicious anemia

1) Serum vitamin B12 level: First, your physician will request a vitamin B12 blood test to determine if your vitamin B12 blood (cobalamin) levels are indeed low. Usually, if test results are positive, then vitamin B12 supplementation begins immediately.

The vitamin B12 blood screening is the most important test for diagnosing vitamin B12 deficiency, and if you respond well to vitamin B12 supplements, then further testing is not usually required.

However, if your doctor suspects pernicious anemia, then he might order one or more of the following additional tests:

2) Complete blood count (CBC): A blood test to screen the amount of red and white blood cells. With pernicious anemia, your red blood cells become engorged and misshapen, resulting in low distribution of red blood cells throughout your body.

3) Serum folate level: Many people who have vitamin B12 deficiency also are deficient in the B vitamin folate.

4) Serum lactate dehydrogenase (LDH): Your doctor might order a blood test measuring LDH levels.

5) Reticulocyte count: This test looks for reticulocytes (slightly immature red blood cells).

6) Homocysteine test: High homocysteine levels in your blood may indicate vitamin B12 deficiency, folate deficiency, or vitamin B6 deficiency.

7) Gastrin level: a test measuring the amount of the hormone gastrin in your blood may help doctors diagnose the cause of vitamin B12 deficiency.

8) Methylmalonic acid (MMA) test– With vitamin B12 deficiency, methylmalonic acid levels go up. The MMA test provides more proof of the existence of vitamin B12 deficiency.

9) Intrinsic factor antibody test: Pernicious anemia is an autoimmune disorder in which sufferers are not able to product intrinsic factor, a necessary hormone for absorbing vitamin B12. Before diagnosing pernicious anemia, your doctor has to confirm the existence of an antibody in your system that inhibits intrinsic factor production, thereby causing vitamin B12 deficiency.

10) Bone marrow staining: Sometimes, your physician might require a bone marrow biopsy in order to determine other potential causes of pernicious anemia or general red blood cell disorders.

Do you have Franken-DNA from Pernicious Anemia?

What about the Schilling test for vitamin B12 deficiency?

In the past, doctors have used the Schilling test to diagnose vitamin B12 deficiency. The Schilling test involves swallowing harmless, radioactive doses of vitamin B12 and tracking its progress in your body. However, because it involves fasting and the use of low-dose radiation, and because it may cause side effects like nausea, the Schilling test is rarely used.

Schilling test—a test in which a harmless amount of radiation is used to assess whether a vitamin B12 deficiency exists (rarely used)

Vitamin B12 supplementation

Once diagnosed with vitamin B12 deficiency, your doctor will likely prescribe vitamin B12 shots, beginning with 1000 mcg of vitamin B12 per week.

These B12 shots are only available upon prescription.

After the first month, B12 shots may be decreased to once per month, upon doctor’s orders.
If B12 deficiency symptoms (fatigue, muscular pain, and brain fog) continue despite vitamin B12 injections, you may supplement with additional over-the-counter (OTC) vitamin B12.
Once your vitamin B12 levels are normal, your doctor will likely stop vitamin B12 shots in favor of OTC vitamin B12.
Sublingual vitamin B12 are an OTC option that may require supplementation two or three times per day. Side effects may include unpleasant taste and burning, tingling sensation on the tongue.
Note: Sublingual vitamin B12 must be dissolved under the tongue as indicated; if they are chewed or swallowed, then vitamin B12 will not be absorbed.

Please tell us…

Aside from taking the blood test for vitamin B12, have you received any of the other tests mentioned?
Please share your experience with vitamin B12 supplementation.
We welcome all comments, questions, or suggestions!

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