Low levels of vitamin B12 can persist in the early resettlement of refugees: symptoms, screening and monitoring.
BACKGROUND
Many refugees have vitamin B12 (B12) deficiency. It has been assumed that deficiency would be predictable from macrocytosis or symptoms, and borderline levels would improve after a period of resettlement in countries rich with animal-source foods. We explored B12 levels and symptoms soon after the refugees' arrival and 4-8 months after settlement in Australia.


METHODS
Newly arrived refugees aged >18 years (n = 136) were tested for vitamin B12 and haematological indices. They also completed a language-validated questionnaire, which they repeated 4-8 months after arrival. B12 levels were reassessed in patients with levels ≤240 pmol at baseline.


RESULTS
We found that 21 participants (15%) had low levels of B12  (≤150 pmol/L) and 65 (48%) had borderline B12 levels  (151-240 pmol/L). There was no relationship between B12 level and mean corpuscular volume, ferritin or symptoms. Borderline B12 levels persisted in 64% of participants at follow-up and deficiency developed in 11%.


CONCLUSIONS
B12 levels cannot be predicted from macrocytosis or symptoms, and may not 'self-correct' after resettlement. Health assessments for newly arrived refugees should include B12 measurement and those with borderline levels should be followed up.
AM MBBS, DCH, FACPsychMed, MPH, is Director, Health in Human Diversity unit, Discipline of General Practice, university of Adelaide, Senior Medical Officer, Migrant Health Service, Adelaide and Medical Director, Kakarrara Wilurrara Health Alliance.
Jill
J
Benson
Christine
C
Phillips
Margaret
M
Kay
Hoda
H
Hanifi
Gauri
G
Giri
Catherine
C
Leahy
Michelle
M
Lorimer
D000328:Adult; D001315:Australia; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D012036:Refugees; D014805:Vitamin B 12 / Q000627:therapeutic use; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis* / Q000188:drug therapy
D014805:Vitamin B 12