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%. Conclusion 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.