This protocol applies to patients presenting with neurological manifestations of vitamin B12 deficiency where the underlying cause falls into one of three specific categories: autoimmune gastritis, prior total gastrectomy, or prior complete terminal ileal resection.
The protocol covers vitamin B12 deficiency — presenting with neurological manifestations — when attributable to:
For patients in this group, management is built around a specific, lifelong form of vitamin B12 replacement — the complete regimen, including its structure and delivery, is set out in the full protocol.
The aim is to increase vitamin B12 concentrations. Symptom improvement may begin within 2 weeks, though full response can take up to 3 months.
Offer lifelong intramuscular vitamin B12 replacement to people if: autoimmune gastritis is the cause, or suspected cause, of vitamin B12 deficiency or they have had a total gastrectomy, or a complete terminal ileal resection.
Patients should be informed that their symptoms could start to improve within 2 weeks, but this may take up to 3 months. The aim of treatment is to increase vitamin B12 concentrations.
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