A practical guide to management in primary care
Science bitClinical presentation and complicationsInvestigationsManagementDiscussion of guidelinesMini audit of our patients
Derived from the diet found in meat, fish, eggs, milk but not in plantsUp to 2yrs worth are stored in the liver.
Impaired absorptionPernicious anaemiaGastrectomyIleal disease or resectionMalabsorption syndromes Low dietary intakeVegans
Autoimmune disease antibodies are formed against the parietal cells. This produces atrophic gastritis and reduced IF production.1:8000 of over 60sF>MAll races but more common in fair skin, blue eyed peopleAssociated with other AA diseases particularly thyroid diseases, addisons and vitiligo
FBC Megaloblastic anaemia with hypersegmented neutrophils.B12 levels lowParietal cell antibodies - +ve in 90%Bilirubin may be raised Serum Folate may be normal or highShilling testEndoscopy shows atrophic gastric mucosa
B12 Deficiency without neurological involvement:1mg Hydroxocobalamin 3 times a week for 2 weeks then every 3 months.B12 Deficiency with neurological involvement:1mg Hydroxocobalamin very other day until no further improvement then every 2months.
Prodigy (CKS) guidelines
60 patients with Hydroxocobalamin prescribed.Ave age 70yrs (34-95)58% female 42% male
Do we routinely monitor patients on B12 injections?Do we consistently give B12 every 3months?Do we document (or investigate) the cause of the B12 deficiency?
Chart1
24
36
Sheet1
Number of inj in last 2 yrsNumber of pat.
Zero12
One3
Two1
Three6
Four5
Five1
Six10
Severn3
Eight7
Nine5
Ten3
Eleven2
Twelve2
Mean4.6153846154
Monitoring24
No monitoring36
Cause of B12 deff
Nil recorded28
Pernicious anaemia18
Gastrectomy5
Crohns5
Small bowel resection2
?Diet2
Sheet1
0
0
0
0
0
0
0
0
0
0
0
0
0
B12
0
0
0
0
0
0
0
0
NHS numberTitleFirst NameSurnameSexDate of birthAgeAddressHow many inj in last 2 yearsBlood monitoring in last 1yrComplications?Under specialist?cause Identified?
4068804303MrRonaldAllenMale17-Nov-287920 Crown Hill,Rayleigh, Essex9(sep 07)yesNeuropathy, MCVNoNo
6123458973MrsMargaretAveryFemale14-Nov-307740 Louis Drive East, Rayleigh, Essex0(1999)NoMCV anaemiaGastroPernicious Anaemia, Crohns
6042924737MrRonaldBramleyMale7-Dec-307777 Love Lane,Rayleigh, Essex9 (2002)YesNilGAstroGastrectomy/ 'iron def anaemia'
4526144657MrsJanetBrownFemale12-Mar-5454615 Rayleigh Road, Eastwood, Leigh-On-Sea, Essex4 (1990)yesAnaemia,Gastrocrohns
6042707256MsJeanBuckFemale9-Nov-347321 Pearsons Avenue,Rayleigh, Essex8 (1994)yesno
6206077594MrSantalinaBuckleyMale20-Dec-26813 Pargat Drive, Eastwood, Leigh-On-Sea, Essex4 ( jul07)NoAnaemic MCVNoNo
4525513640MrsTeresaCappFemale3-Aug-5156221 Green Lane, Eastwood, Leigh-On-Sea, Essex9 (1999)YesNo
4167385163MrsMaryCarterFemale8-Jun-30788 Mount Avenue,Rayleigh, Essex1 (2006)NoNo
4143406152MrLeslieCawkwellMale8-Apr-23859 Britton Court Finchfield,Rayleigh, Essex6 (2002)YesAnaemia MCVNoPernicious Anaemia
4128282782MrDonaldChristieMale1-Jan-278151 Queens Road,Rayleigh, Essex10(1994) DNNoNoPartial gastrectomy
4924135100MrsDorisClareFemale3-Aug-287934 Nelson Road,Rayleigh, Essex0(2001)No (but normal FBC'08)No
4800457726MsCaroleCoffinFemale1-Nov-594899 Lower Lambricks, Rayleigh, Essex0(2005)No(normal FBC '07)NilNo?diet
4641311625MrJohnDelaneyMale29-Dec-317668 Wyburns Ave,Rayleigh, Essex8(2006)Yesanaem. MCVNopernicious
4004600049MsBerylDobsonFemale3-Apr-29798 York Rd,Rayleigh, Essex8(1990)Yes
4701078476MissDawnFullerFemale24-Jun-6642124 Eastwood Road,Rayleigh, Essex6(1980)Yescrohns
4025790688MrsLilianGaulFemale10-May-1791Rosedale Court, Hockley Road, Rayleigh, Essex0(2004)NoNilNo?pernicious anaem
4389007599MrsKellie-AnneGoodyFemale28-Aug-69389 Warwick Road,Rayleigh, Essex1(2004)YesNo
4544074983MrAnthonyGraingerMale12-Apr-476158 Upway,Rayleigh, Essex6(1993)YesnilNoNo
4129971484MsPeggyGreasleyFemale22-Dec-23849 Hanover Court, Barringtons Close,Rayleigh, Essex4(Jan 08)NoAnaemicNoNo
4085035703MrsMarionGreenFemale23-Jul-416720 Southview Close,Rayleigh, Essex0(2003)NoNilYes?diet
4524337687Mr.AlanHallMale2-Jul-47619 Disraeli Road,Rayleigh, Essex7(2002)NoGastro
4083916192MrJamesHallMale15-Jan-13956 Dobsons House, Dobsons Close,Rayleigh, Essex3(2002)YesAnaemicno?pernicious anaem
4270593539MrDavidHarrisMale7-Sep-713639 Avondale Road,Rayleigh, Essex0(1996)NoAnaemiaGastroCrohns
4129969749MrMichaelHarveyMale11-Feb-37717 Bramfield Rd West,Rayleigh, Essex8(2005)NoNoNo
6129289278MrRonaldHaynesMale31-Jul-24846 Nelson Gdns,Rayleigh, Essex7(1990)YesAnaemianopernicious anaem
4084781266Mr.DennisHillMale29-Dec-4661The Hunnypot, 14 Finchfield, Rayleigh, Essex3(joined surgeryjan08)
4402507286MsJoyceHillsonFemale5-Jul-377112 Dene Gardens,Rayleigh, Essex10(1990)YesAnaemiaNoPernicious anaea
4084532363MrPeterHorwoodMale19-Aug-406741 Church Road,Rayleigh, Essex12(1999)YesAnaemia MCV SCDC
4203045207MrCharlesHuntMale2-Feb-357313 Roach Avenue,Rayleigh, Essex4(2003)YesNo
4129630679MrsMavisIlesFemale7-Jun-327632 Willow Drive,Rayleigh, Essex12(2002)YesNoShort bowel syn
4021799648MrsFrancesIlinesFemale20-Jul-22864 Britton Court, Finchfield, Rayleigh, Essex11(2006)Yesanaemia
4208522801MissLisaJacquesFemale8-Oct-773046 Avondale Road,Rayleigh, Essex9(2003)YesAnaemicNo
6166233388MrWilliamJamesMale3-Jan-317716 Gravel Road, Eastwood, Leigh-On-Sea, Essex8(2001)YesNilTotal Gastrec
4128174793MsRubyJephsonFemale12-Nov-258217 Victoria Road,Rayleigh, Essex11(1999)YesGlossitisNo
4642552693MrDouglasKempMale1-Feb-3276Apthorpe, St Johns Drive,Rayleigh, Essex6(2008)NoPerioheral neuropathyNo
4665544573MrsEileenKhanFemale10-Mar-357317 Bracken Dell,Rayleigh, Essex9(1990)YesAnaemiaNoPernicious an
4270480017MrsDianeKiernanFemale26-Mar-654318 Belgrave Close,Rayleigh, Essex3(2008)YesAnaemiaNocrohns
4567451635MrJohnLarnerMale27-Aug-5849135 Eastwood Road,Rayleigh, Essex0(2005)NoAnaemicNoPernicious
4580246241MsMaryLattawayFemale5-Jan-495992 Clarence Road,Rayleigh, Essex8(2006)YesMVCNo
6166726384MrsVioletLeeFemale17-Jul-20881 Parkway,Rayleigh, Essex7(2000)NoNOPernicious
4270631368MissJenniferMakepeaceFemale3-Aug-733450 Oakley Avenue,Rayleigh, Essex1(2004)NonilNoSmall bowel resection
4080915543MrsDorisMc AlpineFemale5-Oct-228512 Humber Close,Rayleigh, Essex10(1990)NoNo
6108422564MrThomasMorrisMale22-Oct-367133 Downhall Close,Rayleigh, Essex6(2001)YesnilNoPerinic
6168658173MrsIvyNashFemale8-Oct-37702 Brocksford Avenue,Rayleigh, Essex2(2005)Yes
4069690204MrsPaulineNeasterFemale18-Dec-367124 The Lavers, Hockley Road,Rayleigh, Essex0(2005)Yes
4023232645MrsIrisNicholsonFemale6-Aug-406722 Albany Road,Rayleigh, Essex0(2001)No
4663055443MrChandrakantPatelMale29-Sep-357281A Nelson Road,Rayleigh, Essex6(1998)Yescrohns
6284685920MrsReshmaPatelFemale15-Dec-7136202 Green Lane,Leigh-On-Sea, Essex3(2007)NoAnaemiaNo
4081810281MrsKathleenPimmFemale23-Jan-268267 High Mead,Rayleigh, Essex3(1990)YesPernicious
4007360081MrSydneyPlattMale20-Nov-426514 Leslie Gardens,Rayleigh, Essex4(1994)YesMVCNoPernicious
4005928234MrsHildaPopeFemale9-Jul-14942 Frances Cottee Lodge, Clarence Road,Rayleigh, Essex0(1994)NoAnaemicNoPernicious
4129633333MrsDorothyPrestonFemale24-May-307854 Clarence Road,Rayleigh, Essex6(2006)YesAnaemiaNoPernicious
6045659872MrsVeraPrykeFemale30-Jun-387052 Britton Court, Finchfield, Rayleigh, Essex0(2003)NoPernicious
4023090476MrDanielReganMale18-Nov-268120 Bull Lane,Rayleigh, Essex8(1991)Yesanaemia?gastrectomy
6167531838MrHarrySparrowMale4-Jul-367299 Eastwood Road,Rayleigh, Essex6(1993)YesanaemiaNoPartial gastrectomy
4129756729MrLeslieStensonMale16-Sep-278031 Teignmouth Drive,Rayleigh, Essex6(2005)YesMVCNoPernicious
4162171610MsEileenStoffellFemale12-Oct-268127 Shannon Avenue,Rayleigh, Essex3(2004)YesMCVNo
4106210096MrsLilieTurnerFemale19-Apr-2880217 Bull Lane,Rayleigh, Essex5(feb 07)YesMCVNo
4085276441MrsNormaTurnstillFemale24-Oct-4067168 Grove Road,Rayleigh, Essex0(2000)NoPernicious
4686486963MrNeilWilcockMale3-Jul-31774 The Ramparts, Rayleigh, Essex6(2000)Yes
Ave age69.9534-95
male25
female35
Chart4
12
3
1
6
5
1
10
3
7
5
3
2
2
No. injections
no. patients
Sheet1
Number of inj in last 2 yrsNumber of pat.
Zero12
One3
Two1
Three6
Four5
Five1
Six10
Severn3
Eight7
Nine5
Ten3
Eleven2
Twelve2
Mean4.6153846154
Monitoring24
No monitoring36
Cause of B12 deff
Nil recorded28
Pernicious anaemia18
Gastrectomy5
Crohns5
Small bowel resection2
?Diet2
Sheet1
No. injections
no. patients
B12
NHS numberTitleFirst NameSurnameSexDate of birthAgeAddressHow many inj in last 2 yearsBlood monitoring in last 1yrComplications?Under specialist?cause Identified?
4068804303MrRonaldAllenMale17-Nov-287920 Crown Hill,Rayleigh, Essex9(sep 07)yesNeuropathy, MCVNoNo
6123458973MrsMargaretAveryFemale14-Nov-307740 Louis Drive East, Rayleigh, Essex0(1999)NoMCV anaemiaGastroPernicious Anaemia, Crohns
6042924737MrRonaldBramleyMale7-Dec-307777 Love Lane,Rayleigh, Essex9 (2002)YesNilGAstroGastrectomy/ 'iron def anaemia'
4526144657MrsJanetBrownFemale12-Mar-5454615 Rayleigh Road, Eastwood, Leigh-On-Sea, Essex4 (1990)yesAnaemia,Gastrocrohns
6042707256MsJeanBuckFemale9-Nov-347321 Pearsons Avenue,Rayleigh, Essex8 (1994)yesno
6206077594MrSantalinaBuckleyMale20-Dec-26813 Pargat Drive, Eastwood, Leigh-On-Sea, Essex4 ( jul07)NoAnaemic MCVNoNo
4525513640MrsTeresaCappFemale3-Aug-5156221 Green Lane, Eastwood, Leigh-On-Sea, Essex9 (1999)YesNo
4167385163MrsMaryCarterFemale8-Jun-30788 Mount Avenue,Rayleigh, Essex1 (2006)NoNo
4143406152MrLeslieCawkwellMale8-Apr-23859 Britton Court Finchfield,Rayleigh, Essex6 (2002)YesAnaemia MCVNoPernicious Anaemia
4128282782MrDonaldChristieMale1-Jan-278151 Queens Road,Rayleigh, Essex10(1994) DNNoNoPartial gastrectomy
4924135100MrsDorisClareFemale3-Aug-287934 Nelson Road,Rayleigh, Essex0(2001)No (but normal FBC'08)No
4800457726MsCaroleCoffinFemale1-Nov-594899 Lower Lambricks, Rayleigh, Essex0(2005)No(normal FBC '07)NilNo?diet
4641311625MrJohnDelaneyMale29-Dec-317668 Wyburns Ave,Rayleigh, Essex8(2006)Yesanaem. MCVNopernicious
4004600049MsBerylDobsonFemale3-Apr-29798 York Rd,Rayleigh, Essex8(1990)Yes
4701078476MissDawnFullerFemale24-Jun-6642124 Eastwood Road,Rayleigh, Essex6(1980)Yescrohns
4025790688MrsLilianGaulFemale10-May-1791Rosedale Court, Hockley Road, Rayleigh, Essex0(2004)NoNilNo?pernicious anaem
4389007599MrsKellie-AnneGoodyFemale28-Aug-69389 Warwick Road,Rayleigh, Essex1(2004)YesNo
4544074983MrAnthonyGraingerMale12-Apr-476158 Upway,Rayleigh, Essex6(1993)YesnilNoNo
4129971484MsPeggyGreasleyFemale22-Dec-23849 Hanover Court, Barringtons Close,Rayleigh, Essex4(Jan 08)NoAnaemicNoNo
4085035703MrsMarionGreenFemale23-Jul-416720 Southview Close,Rayleigh, Essex0(2003)NoNilYes?diet
4524337687Mr.AlanHallMale2-Jul-47619 Disraeli Road,Rayleigh, Essex7(2002)NoGastro
4083916192MrJamesHallMale15-Jan-13956 Dobsons House, Dobsons Close,Rayleigh, Essex3(2002)YesAnaemicno?pernicious anaem
4270593539MrDavidHarrisMale7-Sep-713639 Avondale Road,Rayleigh, Essex0(1996)NoAnaemiaGastroCrohns
4129969749MrMichaelHarveyMale11-Feb-37717 Bramfield Rd West,Rayleigh, Essex8(2005)NoNoNo
6129289278MrRonaldHaynesMale31-Jul-24846 Nelson Gdns,Rayleigh, Essex7(1990)YesAnaemianopernicious anaem
4084781266Mr.DennisHillMale29-Dec-4661The Hunnypot, 14 Finchfield, Rayleigh, Essex3(joined surgeryjan08)
4402507286MsJoyceHillsonFemale5-Jul-377112 Dene Gardens,Rayleigh, Essex10(1990)YesAnaemiaNoPernicious anaea
4084532363MrPeterHorwoodMale19-Aug-406741 Church Road,Rayleigh, Essex12(1999)YesAnaemia MCV SCDC
4203045207MrCharlesHuntMale2-Feb-357313 Roach Avenue,Rayleigh, Essex4(2003)YesNo
4129630679MrsMavisIlesFemale7-Jun-327632 Willow Drive,Rayleigh, Essex12(2002)YesNoShort bowel syn
4021799648MrsFrancesIlinesFemale20-Jul-22864 Britton Court, Finchfield, Rayleigh, Essex11(2006)Yesanaemia
4208522801MissLisaJacquesFemale8-Oct-773046 Avondale Road,Rayleigh, Essex9(2003)YesAnaemicNo
6166233388MrWilliamJamesMale3-Jan-317716 Gravel Road, Eastwood, Leigh-On-Sea, Essex8(2001)YesNilTotal Gastrec
4128174793MsRubyJephsonFemale12-Nov-258217 Victoria Road,Rayleigh, Essex11(1999)YesGlossitisNo
4642552693MrDouglasKempMale1-Feb-3276Apthorpe, St Johns Drive,Rayleigh, Essex6(2008)NoPerioheral neuropathyNo
4665544573MrsEileenKhanFemale10-Mar-357317 Bracken Dell,Rayleigh, Essex9(1990)YesAnaemiaNoPernicious an
4270480017MrsDianeKiernanFemale26-Mar-654318 Belgrave Close,Rayleigh, Essex3(2008)YesAnaemiaNocrohns
4567451635MrJohnLarnerMale27-Aug-5849135 Eastwood Road,Rayleigh, Essex0(2005)NoAnaemicNoPernicious
4580246241MsMaryLattawayFemale5-Jan-495992 Clarence Road,Rayleigh, Essex8(2006)YesMVCNo
6166726384MrsVioletLeeFemale17-Jul-20881 Parkway,Rayleigh, Essex7(2000)NoNOPernicious
4270631368MissJenniferMakepeaceFemale3-Aug-733450 Oakley Avenue,Rayleigh, Essex1(2004)NonilNoSmall bowel resection
4080915543MrsDorisMc AlpineFemale5-Oct-228512 Humber Close,Rayleigh, Essex10(1990)NoNo
6108422564MrThomasMorrisMale22-Oct-367133 Downhall Close,Rayleigh, Essex6(2001)YesnilNoPerinic
6168658173MrsIvyNashFemale8-Oct-37702 Brocksford Avenue,Rayleigh, Essex2(2005)Yes
4069690204MrsPaulineNeasterFemale18-Dec-367124 The Lavers, Hockley Road,Rayleigh, Essex0(2005)Yes
4023232645MrsIrisNicholsonFemale6-Aug-406722 Albany Road,Rayleigh, Essex0(2001)No
4663055443MrChandrakantPatelMale29-Sep-357281A Nelson Road,Rayleigh, Essex6(1998)Yescrohns
6284685920MrsReshmaPatelFemale15-Dec-7136202 Green Lane,Leigh-On-Sea, Essex3(2007)NoAnaemiaNo
4081810281MrsKathleenPimmFemale23-Jan-268267 High Mead,Rayleigh, Essex3(1990)YesPernicious
4007360081MrSydneyPlattMale20-Nov-426514 Leslie Gardens,Rayleigh, Essex4(1994)YesMVCNoPernicious
4005928234MrsHildaPopeFemale9-Jul-14942 Frances Cottee Lodge, Clarence Road,Rayleigh, Essex0(1994)NoAnaemicNoPernicious
4129633333MrsDorothyPrestonFemale24-May-307854 Clarence Road,Rayleigh, Essex6(2006)YesAnaemiaNoPernicious
6045659872MrsVeraPrykeFemale30-Jun-387052 Britton Court, Finchfield, Rayleigh, Essex0(2003)NoPernicious
4023090476MrDanielReganMale18-Nov-268120 Bull Lane,Rayleigh, Essex8(1991)Yesanaemia?gastrectomy
6167531838MrHarrySparrowMale4-Jul-367299 Eastwood Road,Rayleigh, Essex6(1993)YesanaemiaNoPartial gastrectomy
4129756729MrLeslieStensonMale16-Sep-278031 Teignmouth Drive,Rayleigh, Essex6(2005)YesMVCNoPernicious
4162171610MsEileenStoffellFemale12-Oct-268127 Shannon Avenue,Rayleigh, Essex3(2004)YesMCVNo
4106210096MrsLilieTurnerFemale19-Apr-2880217 Bull Lane,Rayleigh, Essex5(feb 07)YesMCVNo
4085276441MrsNormaTurnstillFemale24-Oct-4067168 Grove Road,Rayleigh, Essex0(2000)NoPernicious
4686486963MrNeilWilcockMale3-Jul-31774 The Ramparts, Rayleigh, Essex6(2000)Yes
Ave age69.9534-95
male25
female35
Chart5
28
18
5
5
2
2
Sheet1
Number of inj in last 2 yrsNumber of pat.
Zero12
One3
Two1
Three6
Four5
Five1
Six10
Severn3
Eight7
Nine5
Ten3
Eleven2
Twelve2
Mean4.6153846154
Monitoring24
No monitoring36
Cause of B12 deff
Nil recorded28
Pernicious anaemia18
Gastrectomy5
Crohns5
Small bowel resection2
?Diet2
Sheet1
No. injections
no. patients
B12
NHS numberTitleFirst NameSurnameSexDate of birthAgeAddressHow many inj in last 2 yearsBlood monitoring in last 1yrComplications?Under specialist?cause Identified?
4068804303MrRonaldAllenMale17-Nov-287920 Crown Hill,Rayleigh, Essex9(sep 07)yesNeuropathy, MCVNoNo
6123458973MrsMargaretAveryFemale14-Nov-307740 Louis Drive East, Rayleigh, Essex0(1999)NoMCV anaemiaGastroPernicious Anaemia, Crohns
6042924737MrRonaldBramleyMale7-Dec-307777 Love Lane,Rayleigh, Essex9 (2002)YesNilGAstroGastrectomy/ 'iron def anaemia'
4526144657MrsJanetBrownFemale12-Mar-5454615 Rayleigh Road, Eastwood, Leigh-On-Sea, Essex4 (1990)yesAnaemia,Gastrocrohns
6042707256MsJeanBuckFemale9-Nov-347321 Pearsons Avenue,Rayleigh, Essex8 (1994)yesno
6206077594MrSantalinaBuckleyMale20-Dec-26813 Pargat Drive, Eastwood, Leigh-On-Sea, Essex4 ( jul07)NoAnaemic MCVNoNo
4525513640MrsTeresaCappFemale3-Aug-5156221 Green Lane, Eastwood, Leigh-On-Sea, Essex9 (1999)YesNo
4167385163MrsMaryCarterFemale8-Jun-30788 Mount Avenue,Rayleigh, Essex1 (2006)NoNo
4143406152MrLeslieCawkwellMale8-Apr-23859 Britton Court Finchfield,Rayleigh, Essex6 (2002)YesAnaemia MCVNoPernicious Anaemia
4128282782MrDonaldChristieMale1-Jan-278151 Queens Road,Rayleigh, Essex10(1994) DNNoNoPartial gastrectomy
4924135100MrsDorisClareFemale3-Aug-287934 Nelson Road,Rayleigh, Essex0(2001)No (but normal FBC'08)No
4800457726MsCaroleCoffinFemale1-Nov-594899 Lower Lambricks, Rayleigh, Essex0(2005)No(normal FBC '07)NilNo?diet
4641311625MrJohnDelaneyMale29-Dec-317668 Wyburns Ave,Rayleigh, Essex8(2006)Yesanaem. MCVNopernicious
4004600049MsBerylDobsonFemale3-Apr-29798 York Rd,Rayleigh, Essex8(1990)Yes
4701078476MissDawnFullerFemale24-Jun-6642124 Eastwood Road,Rayleigh, Essex6(1980)Yescrohns
4025790688MrsLilianGaulFemale10-May-1791Rosedale Court, Hockley Road, Rayleigh, Essex0(2004)NoNilNo?pernicious anaem
4389007599MrsKellie-AnneGoodyFemale28-Aug-69389 Warwick Road,Rayleigh, Essex1(2004)YesNo
4544074983MrAnthonyGraingerMale12-Apr-476158 Upway,Rayleigh, Essex6(1993)YesnilNoNo
4129971484MsPeggyGreasleyFemale22-Dec-23849 Hanover Court, Barringtons Close,Rayleigh, Essex4(Jan 08)NoAnaemicNoNo
4085035703MrsMarionGreenFemale23-Jul-416720 Southview Close,Rayleigh, Essex0(2003)NoNilYes?diet
4524337687Mr.AlanHallMale2-Jul-47619 Disraeli Road,Rayleigh, Essex7(2002)NoGastro
4083916192MrJamesHallMale15-Jan-13956 Dobsons House, Dobsons Close,Rayleigh, Essex3(2002)YesAnaemicno?pernicious anaem
4270593539MrDavidHarrisMale7-Sep-713639 Avondale Road,Rayleigh, Essex0(1996)NoAnaemiaGastroCrohns
4129969749MrMichaelHarveyMale11-Feb-37717 Bramfield Rd West,Rayleigh, Essex8(2005)NoNoNo
6129289278MrRonaldHaynesMale31-Jul-24846 Nelson Gdns,Rayleigh, Essex7(1990)YesAnaemianopernicious anaem
4084781266Mr.DennisHillMale29-Dec-4661The Hunnypot, 14 Finchfield, Rayleigh, Essex3(joined surgeryjan08)
4402507286MsJoyceHillsonFemale5-Jul-377112 Dene Gardens,Rayleigh, Essex10(1990)YesAnaemiaNoPernicious anaea
4084532363MrPeterHorwoodMale19-Aug-406741 Church Road,Rayleigh, Essex12(1999)YesAnaemia MCV SCDC
4203045207MrCharlesHuntMale2-Feb-357313 Roach Avenue,Rayleigh, Essex4(2003)YesNo
4129630679MrsMavisIlesFemale7-Jun-327632 Willow Drive,Rayleigh, Essex12(2002)YesNoShort bowel syn
4021799648MrsFrancesIlinesFemale20-Jul-22864 Britton Court, Finchfield, Rayleigh, Essex11(2006)Yesanaemia
4208522801MissLisaJacquesFemale8-Oct-773046 Avondale Road,Rayleigh, Essex9(2003)YesAnaemicNo
6166233388MrWilliamJamesMale3-Jan-317716 Gravel Road, Eastwood, Leigh-On-Sea, Essex8(2001)YesNilTotal Gastrec
4128174793MsRubyJephsonFemale12-Nov-258217 Victoria Road,Rayleigh, Essex11(1999)YesGlossitisNo
4642552693MrDouglasKempMale1-Feb-3276Apthorpe, St Johns Drive,Rayleigh, Essex6(2008)NoPerioheral neuropathyNo
4665544573MrsEileenKhanFemale10-Mar-357317 Bracken Dell,Rayleigh, Essex9(1990)YesAnaemiaNoPernicious an
4270480017MrsDianeKiernanFemale26-Mar-654318 Belgrave Close,Rayleigh, Essex3(2008)YesAnaemiaNocrohns
4567451635MrJohnLarnerMale27-Aug-5849135 Eastwood Road,Rayleigh, Essex0(2005)NoAnaemicNoPernicious
4580246241MsMaryLattawayFemale5-Jan-495992 Clarence Road,Rayleigh, Essex8(2006)YesMVCNo
6166726384MrsVioletLeeFemale17-Jul-20881 Parkway,Rayleigh, Essex7(2000)NoNOPernicious
4270631368MissJenniferMakepeaceFemale3-Aug-733450 Oakley Avenue,Rayleigh, Essex1(2004)NonilNoSmall bowel resection
4080915543MrsDorisMc AlpineFemale5-Oct-228512 Humber Close,Rayleigh, Essex10(1990)NoNo
6108422564MrThomasMorrisMale22-Oct-367133 Downhall Close,Rayleigh, Essex6(2001)YesnilNoPerinic
6168658173MrsIvyNashFemale8-Oct-37702 Brocksford Avenue,Rayleigh, Essex2(2005)Yes
4069690204MrsPaulineNeasterFemale18-Dec-367124 The Lavers, Hockley Road,Rayleigh, Essex0(2005)Yes
4023232645MrsIrisNicholsonFemale6-Aug-406722 Albany Road,Rayleigh, Essex0(2001)No
4663055443MrChandrakantPatelMale29-Sep-357281A Nelson Road,Rayleigh, Essex6(1998)Yescrohns
6284685920MrsReshmaPatelFemale15-Dec-7136202 Green Lane,Leigh-On-Sea, Essex3(2007)NoAnaemiaNo
4081810281MrsKathleenPimmFemale23-Jan-268267 High Mead,Rayleigh, Essex3(1990)YesPernicious
4007360081MrSydneyPlattMale20-Nov-426514 Leslie Gardens,Rayleigh, Essex4(1994)YesMVCNoPernicious
4005928234MrsHildaPopeFemale9-Jul-14942 Frances Cottee Lodge, Clarence Road,Rayleigh, Essex0(1994)NoAnaemicNoPernicious
4129633333MrsDorothyPrestonFemale24-May-307854 Clarence Road,Rayleigh, Essex6(2006)YesAnaemiaNoPernicious
6045659872MrsVeraPrykeFemale30-Jun-387052 Britton Court, Finchfield, Rayleigh, Essex0(2003)NoPernicious
4023090476MrDanielReganMale18-Nov-268120 Bull Lane,Rayleigh, Essex8(1991)Yesanaemia?gastrectomy
6167531838MrHarrySparrowMale4-Jul-367299 Eastwood Road,Rayleigh, Essex6(1993)YesanaemiaNoPartial gastrectomy
4129756729MrLeslieStensonMale16-Sep-278031 Teignmouth Drive,Rayleigh, Essex6(2005)YesMVCNoPernicious
4162171610MsEileenStoffellFemale12-Oct-268127 Shannon Avenue,Rayleigh, Essex3(2004)YesMCVNo
4106210096MrsLilieTurnerFemale19-Apr-2880217 Bull Lane,Rayleigh, Essex5(feb 07)YesMCVNo
4085276441MrsNormaTurnstillFemale24-Oct-4067168 Grove Road,Rayleigh, Essex0(2000)NoPernicious
4686486963MrNeilWilcockMale3-Jul-31774 The Ramparts, Rayleigh, Essex6(2000)Yes
Ave age69.9534-95
male25
female35
Were a bit inconsistent with monitoring.Were a bit inconsistent with dosing.BUT: Does this simply reflect tailoring tests and doses to patients individual needs?We should probably pursue the cause of the B12 deficiency (and document this) more often.