Evidence needed please: Can anyone... - Pernicious Anaemi...

Pernicious Anaemia Society

32,672 members24,065 posts

Evidence needed please

Me2801 profile image
5 Replies

Can anyone please direct me to any file/documents/evidence that can back up that my daughter still needs to continue with alternate day injections for neurological problems.I asked a few weeks ago about how to tell when there is no further improvement to neurological symptoms - I realise that she is still slowly improving even though it is now slower. Her GP is convinced that injections since November should be enough as she's never had anyone on them so long...I actually think that's because she's never actually prescribe to BNF guidelines before!

My daughter has an appointment on Friday and feel I need something official to show the GP rather than saying that I've read that for some people it can take a long time.

Many thanks

Written by
Me2801 profile image
Me2801
To view profiles and participate in discussions please or .
5 Replies
clivealive profile image
clivealiveForum Support

Hi Me2801

Treatment of cobalamin deficiency

Current clinical practice within the U.K is to treat cobalamin deficiency with hydroxocobalamin in the intramuscular form outlined in the British National Formulary, BNF,

Standard initial therapy for patients without neurological involvement is 1000 μg intramuscularly (i.m.) three times a week for two weeks, then every three months.

The BNF advises that for Pernicious anaemia and other macrocytic anaemias patients presenting with neurological symptoms should receive 1000 μg i.m. on alternative days until there is no further improvement, then 1 mg every 2 months.

However, the GWG recommends a pragmatic approach in patients with neurological symptoms by reviewing the need for continuation of alternative day therapy after three weeks of treatment

The doctor should have a copy of the BNF Guidelines on his desk'

Hope this helps

Me2801 profile image
Me2801 in reply toclivealive

Thanks - the problem we're having is my daughter's GP thinks 3 months alternate day injections is too long so was looking for some evidence to say can take a lot longer...everything I read says it can but she's not listening!

Foggyme profile image
FoggymeAdministrator in reply toMe2801

Hi Me2801.

Try this:

stichtingb12tekort.nl/weten...

Speaks to the possible necessity of alternate day injections for up to two years in the presence of neurological symptoms.

Also more in it that may help you with your GP. Perhaps you could highlight everything that is relevant to your daughter's case and take it along to your GP.

Though you may have to be quite insistent and make sure he looks at the highlighted bits while you're actually there with him 😄.

Good luck 👍

Me2801 profile image
Me2801 in reply toFoggyme

Thanks that's brilliant...just what I needed!

clivealive profile image
clivealiveForum Support in reply toMe2801

The guideline doesn't say "3 months alternate day injections" but it allows doctors to "deal with things sensibly and realistically in a way that is based on practical rather than theoretical considerations" (the pragmatic approach) by continuing "alternate day therapy after three weeks of treatment"

Only your daughter can "tell when there is no further improvement to neurological symptoms" she should make a list of them, present it to her doctor who should treat her accordingly.

Do you know what your daughter's folate level is as this is essential to process the B12 she is having injected? Maybe her doctor doesn't know about that either.

I'm not a qualified person but there are others on here who will be able to give you good advice.

I wish you both well

Not what you're looking for?

You may also like...

Update for my daughter re loading injections. and the rest.

My daughter has her appt with GP yesterday - she's 19 and although I was planning to go, had to...
Sneedle profile image

Young PA sufferer, advice needed please

Hi, I would just like advice on whether I have told my daughter the right thing. I Buy methyl...
Jcwg profile image

methylmalonic acid test in diagnosis - help needed please

Hi Everyone, This is my first post so your guidance welomed. Saw GP with increasingly worse...

Help please - PA diagnosis

Can anyone please help? So I've just come back from my GP appointment regarding b12 deficiency, and...
helsbells80 profile image

Advice needed please

Hi, I have been experiencing various problems over the years but the last couple of months I seem...

Moderation team

See all
Gambit62 profile image
Gambit62Administrator
Foggyme profile image
FoggymeAdministrator
taka profile image
takaAdministrator

Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.

Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.