CMScript 9 of 2025: Focus on Vitamin B12 Deficiency Anaemia

If you often feel tired, weak, or short of breath, it might be more than just fatigue. Your body could be lacking Vitamin B12, which is important for functions, such as making red blood cells, keeping the nerves healthy, and turning food into energy.

When Vitamin B12 levels are too low, the body cannot produce healthy red blood cells, leading to a condition known as Vitamin B12 Deficiency Anaemia. This affects oxygen flow throughout the body and can cause permanent nerve damage and other health complications if left untreated.

In this edition of the CMScript, we look at what causes the deficiency, how it can be prevented or treated, and what your medical scheme must cover at the PMB level of care.

Signs and Symptoms

Symptoms can develop slowly and may include:

• Constant tiredness or weakness
• Pale or yellow skin
• A sore, red tongue, or bleeding gums
• Tingling or numbness in the hands and feet
• Dizziness and shortness of breath, even with light activity
• Confusion, slower thinking, forgetfulness, and memory loss

Causes and risk factors

The condition can develop for several reasons, including:

• A vegan or vegetarian diet (since Vitamin B12 is mainly found in animal products).
• Absorption problems caused by conditions such as pernicious anaemia, Crohn’s disease, or Celiac disease.
• Certain medications, such as long-term use of metformin.
• Ageing, which can make it harder to absorb Vitamin B12.
• Excessive alcohol use or poor nutrition.

Diagnosis and treatment

Your doctor can confirm Vitamin B12 deficiency by reviewing your symptoms and medical history, conducting blood tests (including a full blood count), and checking other markers such as homocysteine, which may increase when Vitamin B12 is low. In some cases, testing for antibodies that affect Vitamin B12 absorption may also be required.

Treatment usually includes:

• Vitamin B12 supplements or injections.
• Managing underlying causes that affect absorption.
• Dietary changes, such as eating more foods rich in Vitamin B12 (meat, eggs, fish, and dairy) or using fortified foods for vegans.

PMB level of care

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

This means that your medical scheme must cover the diagnosis, treatment, and care 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.
• There are severe symptoms 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.

PMB cover may include blood tests, vitamin B12 supplements (pills or injections), and treatment for related complications. If the deficiency is mild, your care may still be covered under your scheme’s normal benefit structure.

Early diagnosis and care are key to managing this condition effectively. If you often feel tired, dizzy, or experience tingling in your hands and feet, speak to your doctor.

Download the full CMScript here.