5 Cases

10 Categories

Clinical Case Studies

Educational case reports demonstrating B12 deficiency presentation, diagnosis, and management with structured learning points.

Clinician Resources

Difficulty Levels

Foundation

Suitable for medical students and foundation doctors

Intermediate

Suitable for GP trainees and general practitioners

Advanced

Complex cases for specialists and advanced practitioners

Classical Presentation

Classical Pernicious Anaemia Presentation

68 year old female

|Dx: Pernicious Anaemia

Presenting complaint: Progressive fatigue, breathlessness on exertion, and glossitis over 6 months

Pernicious anaemia clusters with other autoimmune conditionsNeurological involvement requires intensive treatment+3 more learning points

Atypical Presentation

Neuropsychiatric Presentation Without Anaemia

52 year old male

|Dx: Subacute Combined Degeneration of the Cord with B12 Deficiency Dementia

Presenting complaint: Personality change, memory problems, and unsteady gait over 3 months

B12 deficiency can present with neuropsychiatric symptoms without anaemiaMMA is essential for diagnosis when serum B12 is borderline+3 more learning points

Paediatric Dietary B12 Deficiency

14 year old female

|Dx: Dietary Vitamin B12 Deficiency with early peripheral neuropathy

Presenting complaint: Tiredness, difficulty concentrating at school, and tingling in hands over 4 months

Vegan diets require B12 supplementation - there are no reliable plant sourcesAdolescents have increased B12 requirements+3 more learning points

Nitrous oxide abuse is an emerging cause of severe B12 deficiency in young people. Consider in any young patient with rapid-onset myeloneuropathy.

Nitrous Oxide-Induced Myeloneuropathy

19 year old male

|Dx: Nitrous Oxide-Induced Myeloneuropathy (Subacute Combined Degeneration)

Presenting complaint: Rapidly progressive numbness in legs, difficulty walking, and bladder symptoms over 2 weeks

Serum B12 is NORMAL in nitrous oxide toxicity - MMA is essentialNitrous oxide toxicity presents with rapid myeloneuropathy+3 more learning points

Metformin-Associated B12 Deficiency in an Elderly Diabetic

78 year old male

|Dx: Metformin-associated B12 deficiency

Presenting complaint: Worsening diabetic neuropathy despite good glycaemic control, increasing fatigue

Screen for B12 deficiency in patients on long-term metforminMetformin-associated neuropathy can mimic or worsen diabetic neuropathy+3 more learning points

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Case Structure

1Presentation & History
2Investigations & Results
3Diagnosis & Reasoning
4Treatment & Outcome
5Learning Points & References

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Additional Resources

NICE CKS: Anaemia - B12 and Folate Deficiency BSH Guidelines BNF: Hydroxocobalamin

Educational Disclaimer: These case studies are for educational purposes only and represent illustrative clinical scenarios. They should not be used as a substitute for clinical judgment or individualised patient care. Always follow your local guidelines and protocols.