Vitamin B12 Deficiency Symptoms and Treatment

By Rudolph Ackermann, CEO at MANAGE ALL
Source: Council for Medical Schemes, October 2025

Vitamin B12 Deficiency Symptoms and Treatment

For the body to function properly, it needs oxygen, which is carried from the lungs to the rest of the body by red blood cells. To produce healthy red blood cells, the body needs certain nutrients, including vitamin B12. This vitamin is important for many functions, such as making red blood cells, keeping the nerves healthy, and turning food into energy. Without enough vitamin B12, the blood and overall health can be affected.

Without enough vitamin B12, red blood cells become larger than normal and shaped differently, which prevents them from working effectively. As a result, the body receives less oxygen, leading to symptoms such as tiredness, weakness, and, over time, possible nerve problems.

Signs and Symptoms

Symptoms can develop slowly and may include:

  • Feeling very tired or weak and light-headed
  • Pale or yellow skin
  • Shortness of breath, even with light activity
  • Dizziness
  • Numbness or tingling in hands or feet
  • Muscle weakness or trouble walking
  • Confusion, slower thinking, forgetfulness, and memory loss
  • Mood or mental changes, such as depression or irritability
  • A sore, red tongue, or bleeding gums
  • Trouble balancing or walking steadily
  • Diarrhoea and weight loss
  • Vision problems

Sometimes nerve-related symptoms appear before anaemia is obvious.

Complications if Untreated

Without treatment, vitamin B12 deficiency anaemia can cause:

  • Permanent nerve damage (numbness, tingling, balance problems, weak muscles)
  • Memory loss, confusion, depression, or mood changes
  • Heart problems from severe anaemia
  • In pregnancy, an increased risk of birth defects in babies

Early detection and treatment reduce these risks.

Treatment and Management

Treatment may include:

  • Vitamin B12 supplements, either pills or injections.
  • Treating underlying causes, like digestive or autoimmune problems.
  • Regular blood tests to monitor vitamin B12 levels and red blood cells.
  • Eating a vitamin B12-rich diet.

If nerve damage is detected early, symptoms often improve, but severe damage may be permanent.

What is covered as PMB level of care?

Vitamin B12 deficiency is a Prescribed Minimum Benefit (PMB) under Diagnosis and Treatment Pair (DTP) code 236K with the descriptor “Iron deficiency; vitamin and other nutritional deficiencies – life-threatening”.

This means it qualifies as a PMB when:

  • The deficiency is severe enough to be life-threatening, for example, when it causes extremely low red blood cell levels, serious heart strain, or other complications that put the person’s health at serious risk.
  • There are severe symptoms or complications, such as:
    • Extreme anaemia (dangerously low oxygen delivery to the body)
    • Permanent nerve damage or severe neurological symptoms
    • Heart problems due to a lack of oxygen in the blood
  • The condition needs immediate and ongoing medical treatment to prevent death or serious long-term damage.

In such cases, the medical scheme must cover the diagnosis, treatment, and care as part of PMBs. This includes blood tests, vitamin B12 supplements (either injection or tablets), and treatment for any complications. However, the medical scheme may use a list of medicines and guidelines to determine how PMB funding is applied. If the deficiency is mild and not causing life-threatening complications, it may still be paid by the scheme, but it would be covered according to the normal benefits of the member’s plan, not necessarily under PMB.

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