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D51.9 - Vitamin B12 Deficiency Anaemia | ICD-10
D51.9 is the ICD-10 code for vitamin B12 deficiency anaemia, unspecified. It causes abnormal red blood cells and can lead to neurological complications if left untreated.
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D51.9 is the ICD-10 code for vitamin B12 deficiency anaemia, unspecified. It causes abnormal red blood cells and can lead to neurological complications if left untreated.
What is D51.9?
The ICD-10 code D51.9 refers to vitamin B12 deficiency anaemia, unspecified. This is a form of anaemia caused by insufficient levels of vitamin B12 (cobalamin) in the body. Vitamin B12 is an essential nutrient required for the production of healthy red blood cells and for the proper functioning of the nervous system. When vitamin B12 is lacking, the bone marrow produces abnormally large, immature red blood cells known as megaloblasts, which cannot carry oxygen efficiently.
Causes
Vitamin B12 deficiency anaemia can arise from a variety of causes:
- Dietary deficiency: Vitamin B12 is found almost exclusively in animal-based foods. Vegans and strict vegetarians are at particular risk of deficiency.
- Malabsorption: Conditions such as Crohn's disease, coeliac disease, or previous stomach surgery can impair the absorption of vitamin B12 in the gastrointestinal tract.
- Pernicious anaemia: An autoimmune condition in which the body lacks intrinsic factor, a protein necessary for vitamin B12 absorption in the intestine. This specific cause is coded under D51.0; D51.9 is used when the precise cause is not specified.
- Medications: Long-term use of metformin or proton pump inhibitors can reduce vitamin B12 absorption over time.
- Increased requirements: During pregnancy and breastfeeding, the demand for vitamin B12 is elevated.
Symptoms
The symptoms of vitamin B12 deficiency anaemia often develop gradually and can include:
- Fatigue, weakness, and persistent tiredness
- Pale or slightly yellowish skin
- Shortness of breath and palpitations during physical activity
- Dizziness and headaches
- Tingling or numbness in the hands and feet (neurological symptoms)
- Difficulties with balance and walking
- Memory problems and difficulty concentrating
- Inflammation of the tongue and mouth (glossitis)
Diagnosis
The diagnosis of vitamin B12 deficiency anaemia is established through several investigations:
- Full blood count: Reveals macrocytosis (enlarged red blood cells) and a low haemoglobin level.
- Serum vitamin B12 level: Values below 200 pg/ml generally indicate deficiency.
- Holotranscobalamin (active B12): An early and sensitive marker of vitamin B12 deficiency.
- Methylmalonic acid and homocysteine: Elevated levels of these metabolites in the blood confirm a functional vitamin B12 deficiency.
- Intrinsic factor antibodies: Tested to rule out pernicious anaemia as the underlying cause.
Treatment
Treatment depends on the underlying cause and the severity of the deficiency:
- Intramuscular injections: In cases of severe deficiency or malabsorption, vitamin B12 is administered by injection into the muscle (e.g. hydroxocobalamin or cyanocobalamin).
- Oral supplementation: For dietary deficiency or mild cases, high-dose oral vitamin B12 supplements can be effective, as a small proportion is absorbed passively without intrinsic factor.
- Dietary changes: Increasing consumption of vitamin B12-rich foods such as meat, fish, eggs, and dairy products.
- Treatment of underlying conditions: Gastrointestinal disorders causing malabsorption should be addressed simultaneously.
With prompt treatment, blood count abnormalities are generally fully reversible. However, neurological damage resulting from prolonged deficiency may only partially improve with treatment.
References
- World Health Organization (WHO): Nutritional Anaemias: Tools for Effective Prevention and Control. WHO Press, Geneva, 2017.
- Stabler SP: Vitamin B12 Deficiency. New England Journal of Medicine. 2013;368(2):149-160.
- Andrès E, Loukili NH, Noel E et al.: Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171(3):251-259.
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