Vitamin B12 deficiency: Why refugee patients are at high risk

Abstract

BACKGROUND: Vitamin B12 is one of the most complex vitamins. The measurement of serum levels and the significance of the results are much debated in the literature. OBJECTIVE: This article discusses testing for vitamin B12 deficiency, its clinical manifestations and the possible repercussions for Australia’s refugee population. DISCUSSION: Full blood count and blood film, iron studies and haemoglobinopathy studies are routinely performed for newly arrived refugees in Australia. At the Migrant Health Service in Adelaide, South Australia, a young woman was found to have a very unusual blood picture with a normal mean cell volume, despite quite severe iron deficiency and thalassaemia trait. Her vitamin B12 was found to be 75 pmol/L. The following week there arose another case of an 11 month old breastfed baby with a vitamin B12 level of 52 pmol/L, whose mother had a level of 300 pmol/L. Understanding the clinical manifestations of vitamin B12 deficiency and how it is relevant to Australia’s refugee population might assist to resolve some of the difficulties that refugees face in Australia.