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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Because the body has large stores of vitamin B-12, a deficiency takes many years to establish so symptoms only develop after years of poor absorption of dietary vitamin B-12.

Symptoms relating to the effects of vitamin B-12 deficiency on the nervous system may appear before symptoms related to the anemia. These symptoms may be vague and nonspecific, especially at the outset. Feelings of numbness, tingling, weakness, lack of coordination, clumsiness, impaired memory, and personality changes may be apparent. The legs are typically more affected than the arms, and usually both sides of the body are affected. When the deficiency is severe, symptoms can worsen, leading to severe weakness, spasticity, paraplegia, and fecal and urinary incontinence.

Importantly, not all people who have vitamin B-12 deficiency and neurological symptoms will have anemia. However, when anemia is present, the typical symptoms of anemia may occur. When red blood cell numbers are reduced from anemia, the heart has to work harder to pump blood to get enough oxygen to the body's tissues. This stress on the heart can cause heart murmurs (an extra or unusual sound heard during the heartbeat), fast or irregular heartbeats, an enlarged heart, or even heart failure. Shortness of breath, fatigue, dizziness, and pale skin are other symptoms of anemia.

A deficiency of vitamin B-12 can also alter the surface of the tongue, making it appear shiny or smooth.

In some cases, pernicious anemia may be present and not cause any symptoms. In this situation, it is usually found incidentally when blood tests are ordered for another reason.

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