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D51.8 – Other Vitamin B12 Deficiency Anaemia
D51.8 is the ICD-10 code for other specified vitamin B12 deficiency anaemias. A lack of vitamin B12 impairs red blood cell production, leading to enlarged, immature cells and anaemia.
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D51.8 is the ICD-10 code for other specified vitamin B12 deficiency anaemias. A lack of vitamin B12 impairs red blood cell production, leading to enlarged, immature cells and anaemia.
What is D51.8?
The ICD-10 diagnosis code D51.8 refers to other specified vitamin B12 deficiency anaemias that are not attributable to a lack of intrinsic factor (D51.0) or purely dietary causes (D51.3). This category encompasses a range of anaemia types in which insufficient vitamin B12 levels disrupt the normal production of red blood cells, resulting in a condition known as megaloblastic anaemia.
Causes
D51.8 covers various underlying causes that do not fit the more specific subcategories:
- Malabsorption syndromes: Conditions such as Crohn's disease, post-gastrectomy states, or bacterial overgrowth of the small intestine can impair vitamin B12 absorption.
- Drug-induced malabsorption: Long-term use of medications such as metformin (for type 2 diabetes) or proton pump inhibitors can reduce vitamin B12 absorption over time.
- Transcobalamin II deficiency: A rare, inherited defect in the transport protein responsible for carrying vitamin B12 in the bloodstream.
- Other metabolic disorders: Rare genetic or acquired disorders affecting vitamin B12 metabolism that do not fall under more specific codes.
Symptoms
The clinical presentation of vitamin B12 deficiency anaemia under D51.8 is similar to other forms of B12 deficiency:
- Pale skin and mucous membranes
- Fatigue, weakness, and general lethargy
- Shortness of breath and palpitations during physical activity
- Tingling or numbness in the hands and feet (peripheral neuropathy)
- Memory problems and difficulty concentrating
- Inflamed, sore tongue (Hunter glossitis)
- Depressive mood or irritability
Diagnosis
Diagnosis is made by a physician based on a combination of tests:
- Complete blood count (CBC): Reveals megaloblastic anaemia with enlarged red blood cells (elevated MCV) and reduced red blood cell counts.
- Serum vitamin B12 level: Values below 200 pg/ml are generally considered deficient.
- Holotranscobalamin (active B12): A more sensitive and earlier marker of vitamin B12 deficiency.
- Methylmalonic acid and homocysteine: Elevated levels confirm a functional vitamin B12 deficiency.
- Investigation of the underlying cause: Depending on clinical suspicion, endoscopy, colonoscopy, stool tests, or genetic testing may be required.
Treatment
Treatment depends on the underlying cause and the severity of the deficiency:
- Intramuscular vitamin B12 injections (cyanocobalamin or hydroxocobalamin): The preferred option in severe anaemia or absorption disorders, as it bypasses gastrointestinal uptake.
- High-dose oral supplementation: May be effective in certain cases, as passive diffusion can occur independently of transport proteins.
- Treatment of the underlying condition: Addressing the root cause, such as adjusting medications or treating bowel disease, is essential for long-term management.
- Regular monitoring: Follow-up blood counts are necessary to assess treatment response and prevent relapse.
References
- Stabler SP. - Vitamin B12 Deficiency. In: New England Journal of Medicine, 2013;368(2):149–160.
- World Health Organization (WHO): Nutritional Anaemias: Tools for Effective Prevention and Control. Geneva: WHO, 2017.
- Green R. et al. - Vitamin B12 deficiency. In: Nature Reviews Disease Primers, 2017;3:17040.
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