NICE Draft Guidelines - separate thread

[dot-dash]

putting as a separate discussion thread

There are several evidence reviews, but the one below has the evidence/trials they reviewed and conclusions they reached.

Additional research is recommended in several key areas - diagnosis, treatment, SI etc

Overall page: nice.org.uk/guidance/indeve...

Summary of the consultation and guidance on comments: nice.org.uk/guidance/indeve...

Draft guidelines themselves: nice.org.uk/guidance/gid-ng...

Evidence review for dose/self-administration: nice.org.uk/guidance/gid-ng...

[helvella]

A few comments - feel free to use or ignore. (I've got enough going on re thyroid without taking on B12 issues!)

Red cell distribution width (RDW) is not mentioned. While right to look at both anaemia and macrocytosis, an elevated RDW can help to draw attention to the possibility of anaemia and macrocytosis co-existing, even if the actual numerical results for MCV are within its reference interval.

There is a prevalent notion that the liver stores sufficient B12 to last for several years. This is misleading and leads to dismissal and lack of urgency on considering treatment. This should be mentioned.

A number of factors mentioned have at least some of their impact due to interruption of the entero-hepatic recirculation of B12. This should be mentioned.

[Cherylclaire Forum Support in reply to helvella]

Yes, absolutely: the "liver stores" story, after all, was crucial to withholding treatment during covid.

Fuctional B12 deficiency seems to need an individual inclusion in (rather scant) symptoms box:

"An innate inability to recognise self in print."

Thanks for the comments made above.