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What Causes Vitamin B12 Deficiency?

Posted on Mon, 11 May 2015

Question: I am a pancreatic cancer patient who underwent distal pancreatectomy, splenectomy, removal of left adrenal then began 6 rounds of Gemzar. during round 2 I had some pins and needles in my toes, after round 3 pins and needles in toes abruptly became feeling like I have pantyhose and long gloves on with pins and needles, I am now having a great deal of difficulty with balance, walking, memory, depression, and a sore tongue. At first we thought neuropathy, but does neuropathy advance that quickly and with those symptoms. I viewed labs and my mcv and rdw are elevated and have been since January (Rnd 3)

Answered by Dr. Hardik Sanghvi (31 minutes later)

Brief Answer:
You should go for sugar and vitamin B12 level.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
You have pancreatic cancer and taking chemotherapy. You should go for blood sugar test and vit b12 level. Your symptoms may be due to diabetes or vitamin B12 deficiency. You have difficulty in balance and memory so you should go for mri brain to rule out any metastatic lesion in brain.
Give me follow up with this reports.
Hope I have answered your question, if you have doubt then I will be happy to answer.
Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Hardik Sanghvi (19 minutes later)

I am an insulin dependent diabetic and monitor my glucose VERY closely and my B12 was checked and is normal. Does neuropathy typically advance that quickly? Is is possible that there is macrocytosis occurring? My concern is that if it is not neuropathy but instead macrocytosis and it is not corrected the neurological damage could be permanent. My greatest concern is that I was in and out of the hospital 3 times during the spring of 2014 and even when I ended up in the emergency room in Aug (when I was diagnosed with PC) NOTHING in my blood work was indicating anything was wrong although I could feel something was not right. My tumor markers were never elevated, all of my blood work looked perfectly normal and was told repeatedly that I should not be concerned because all of my labs looked fine, my lipase was slightly elevated but certainly nothing to be concerned about and I had Stage III PC. My body has a way of masking things, it is weird. So when I saw the elevated mcv of 103 I started researching and became concerned. Could chemotherapy cause macrocytosis?

Answered by Dr. Hardik Sanghvi (16 hours later)

Brief Answer:
Chemotherapy can cause macrocytosis.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern. Chemotherapy can cause macrocytosis as side effects. And macrocytosis can leads to difficulties in maintaining balance, memory loss, tingling and numbness and other symptoms.

If left untreated it can leads to permanent neural damage so you should take treatment of that.

Treatment with vitamin B12 and folic acid supplements are helpful.
Most important thing is to search underlying cause and take treatment of that.

Vitamin b12 and folic acid level, bone marrow examination and thyroid hormone level are done to search the cause.
Then you should take treatment accordingly.

Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar