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Iron with vitamin B12 & D deficiency
My sister is 38 years old, female and vegetarian. Her recent blood tests showed:
• Haemoglobin (Hb): 9.8 g/dL
• MCV: 68 fL
• Serum iron: 34.3
• Vitamin B12: 105
• Vitamin D: 6.28
She has been experiencing fatigue, but her periods are normal.
We would like to understand the appropriate treatment for these deficiencies. Does she need iron, vitamin B12 and vitamin D supplementation, and what dosage/duration is generally recommended for levels this low?
Since she follows a 100% vegetarian diet, what dietary changes should we make to improve iron and B12 levels?
We would especially like to know whether these levels can be managed with oral supplements or whether injections/other treatment may be required.
Answers (30)
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Hello,
Take Balanced diet which is mentioned below,
1/3 of food plate should contain bread ( or 4 roti ), pasta, potato and rice.
1/3 of food plate should contain fruits and vegetables.
1/9 of food plate should contain fish, meat, egg, beans and other non dairy sources of protein.
1/9 of food plate should contain milk and dairy foods.
1/9 of food plate should contain food and drink high in fat and/ or sugar.
plus a glass of milk daily.
For prescription contact me at WhatsApp at +91959508739nine or consult by practo app.
In future if consultations are required than contact me at WhatsApp at +91959508739nine or consult by practo app.
Thanks.
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Kindly consult and give proper detailed history along with symptoms for evaluation and take proper treatment with relevant investigations as required.
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She needs supplements. Give her syp Tonoferron 10m.l. morning and evening for 8 weeks.
Tab neurobion forte one daily for 4 weeks.
She should take more of green leafy vegetables, pumpkin, beetroot, apples, oranges and other citrus fruits, whole grains, berries, milk, curd,paneer.
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Haem up one caplet one at night for 3 months.
Neurokind od after dinner for two to three months.
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Uprise d3 60k weekly once for 8weeks
Then monthly once for 4 month
Inj meaxon in weekly one for 6 week
Follow this every year for oral supplement
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Do consult with me asap and i will correct in min. time
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Need proper evaluation please consult for assessment and treatment
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We need to evaluate the person as whole it's just a single part of the body , needs further extensive evaluation
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She has multiple nutritional deficiency.
Next Steps
need to see if she is bulimic, then s ferritin iron profile and sickling test, s h pylori antigen....
nutrition support is not adequate she will require medicine and b12 and iron injection but only after labs
Health Tips
make sure she is not bulimic and please make her go out in sun in the morning
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Consult
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kindly do connect and consult with me for better treatment plan and advice on your case via PRACTO app
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Post the complete blood count, reticulocyte index, iron profile, liver profile, and kidney profile. Only then one can interpret better.
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Hello,
I am Dr. Romain Rajan, General Physician (Ex Govt Medical Officer at RML Hospital, New Delhi), and your case has been allotted to me.
Thank you for sharing the reports. Her results suggest significant iron deficiency anemia along with marked vitamin B12 and vitamin D deficiency, which can certainly contribute to fatigue.
Her Hb of 9.8 with MCV 68 indicates a microcytic anemia, and the low serum iron supports iron deficiency. However, I would recommend checking serum ferritin, transferrin saturation and a peripheral smear to assess the iron stores and confirm the cause. Even with normal periods, dietary deficiency, reduced absorption or occult blood loss should be considered.
What she should do now
⢠Iron: Oral iron is generally the first choice. A preparation providing approximately 60 to 100 mg elemental iron once daily, or on alternate days if poorly tolerated, is commonly used. Continue until Hb normalises and usually for around 3 months afterwards to replenish iron stores.
⢠Vitamin B12: A level of 105 is significantly low. Oral high dose B12 can work well in many patients, but injections may be preferred initially if there are neurological symptoms, significant malabsorption, or a poor response to oral therapy. The exact regimen should be decided after clinical assessment.
⢠Vitamin D: A level of 6.28 represents severe deficiency. A commonly recommended adult regimen in India is cholecalciferol 60,000 IU once weekly for 12 weeks, followed by maintenance therapy, with repeat testing as advised.
Vegetarian dietary measures
For iron, include regularly:
⢠Lentils, rajma, chickpeas and other dals
⢠Soybean, tofu and soy products
⢠Sesame seeds, pumpkin seeds and nuts
⢠Green leafy vegetables
⢠Dates, raisins and other dried fruits
Take vitamin C rich foods such as lemon, amla, guava or oranges along with iron rich meals. Avoid tea or coffee close to iron containing meals because they can reduce iron absorption.
For B12, vegetarian diets often provide insufficient B12 naturally. Milk, curd, paneer and fortified foods can contribute, but with a level of 105, diet alone is unlikely to correct the deficiency adequately, so supplementation is important.
Because she has multiple significant deficiencies, I would recommend starting treatment under medical supervision rather than relying only on diet. Her CBC should be reassessed after about 3 to 4 weeks to ensure that haemoglobin is responding. If oral iron is not tolerated or there is inadequate response, intravenous iron can be considered.
Please share her ferritin, complete CBC including RDW, transferrin saturation and any previous B12 reports if available. This would help determine the most appropriate treatment and whether injections are actually necessary.
For personalised one to one consultation regarding her deficiencies and treatment plan, you can reach out to me directly on WhatsApp at 80762047 three eight.
Wishing her good health and a speedy recovery.
Dr. Romain Rajan
General Physician
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Take supplements
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Your sister’s reports suggest significant iron deficiency anemia, vitamin B12 deficiency and severe vitamin D deficiency.
Iron: Hb 9.8 and MCV 68 suggest iron-deficiency anemia. Please check serum ferritin, TIBC and transferrin saturation before deciding the dose. If confirmed, oral iron is usually sufficient; injections are considered if oral iron is not tolerated or doesn’t work.
Vitamin B12: Level 105 is quite low. B12 supplementation is required. Oral B12 can usually be used, but injections may be needed if there are neurological symptoms or problems with absorption.
Vitamin D: Level 6.28 is severely low and needs replacement, commonly with high-dose vitamin D for about 6–8 weeks followed by maintenance.
Diet: Include dals, beans, chickpeas, soy/tofu, green leafy vegetables, seeds and nuts for iron, along with vitamin-C-rich foods. Avoid tea/coffee close to iron-containing meals or tablets. For B12, dairy/eggs and B12-fortified foods can help, but supplementation is usually necessary at this level.
Since the MCV is quite low, thalassemia trait should also be considered if iron studies are not clearly deficient or if the microcytosis persists after treatment.
For further advice and assistance, please consult me by taking a prior appointment.
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These reports suggest significant iron-deficiency anaemia with low vitamin D; B12 is borderline low. Fatigue can be due to anaemia, but the cause of iron loss should be checked even with normal periods. Oral iron is usually effective, but the dose and duration should be based on weight, tolerance and repeat CBC/ferritin. Vitamin D replacement should be taken as a planned course, not indefinitely.
Next Steps
Please consult a physician with the complete CBC, ferritin, B12 and vitamin D reports; dietary deficiency and occult blood loss may need evaluation. I can review the reports and guide supplementation through a Practo consultation or at Synergy Multispeciality Hospital, Miraj.
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Take supplements
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Hi
Vitamin B12 and D levels are extremely low for your sister. Both needs IV medicine. Her iron is low too.
When so many vitamins and minerals are low it's better to find out the reason behind it, rather than treating their deficiency alone.
Next Steps
feel free to consult me on practo for further evaluation and management
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If you would like to discuss your concern in more detail, please feel free to contact me on WhatsApp at eight six one nine six six nine nine zero six. Alternatively, you can connect with me through the Practo app for a detailed consultation
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You need supplements but dosage as prescribed by physician do not take by your own .
Next Steps
with supplements you must follow a healthy diet
include green leafy vegetables seasonal fruits also lemon beetroot and amla juice For vit D take 15 min morning sunlight
put curd in cloth and after straining water eat 1 Katori daily ,drink milk ,include paneer
Health Tips
consult for dosage of supplements and must follow diet routine
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Avoid fried and spicy food
Water intake more
Green leafy vegetables more
Fiber meal
Walk
Do connect and consult
Will help you
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Do consult
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Dr. Sumit Verma
General Physician
5 yrs exp
Kanpur
1 # Eat a balanced diet
Plenty of vegetables, fruits,
whole grains, pulses, nuts, and seeds.
Limit ultra-processed foods, excess sugar, and excessive salt.
Choose healthy protein sources and healthy fats.
2 # Stay physically active
Aim for at least 150 minutes of moderate exercise per week.
Include strength training 2–3 times weekly.
3 # Maintain a healthy weight
Excess body weight increases the risk of many chronic diseases.
4 # Get adequate sleep
Most adults need 7–9 hours of quality sleep each night.
5 # Stay hydrated
Drink enough water throughout the day.
6 # Avoid tobacco and limit alcohol
Smoking and tobacco use significantly increase disease risk.
7 #Manage stress
Meditation, yoga, hobbies, social connections, and relaxation techniques can help.
8 # Practice good hygiene
Wash hands regularly and follow food-safety practices
9 # Have regular health checkups
Monitor blood pressure, blood sugar, cholesterol, dental health, and vision as recommended.
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Dr. Anuj Mothsra
General Practitioner
7 yrs exp
Jhunjhunu
Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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Dr. Vetsa Sri Krishna Chaitanya
General Physician
7 yrs exp
Rajahmundry
Need a few more details please consult for further evaluation and treatment
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Dr. Suhail Shameem Naikoo
General Physician
1 yrs exp
Doda
Oral iron + high-dose oral B12 + oral D3 will often be enough, but the cause of the iron/B12 deficiency should b evaluated
Next Steps
Go get some tests done IRON profile ,peripheral blood smear,folate,retic count
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Dr. Reesha Varshney
General Physician
1 yrs exp
Hathras
These levels shouldn't be ignored on the very first place
Secondly such levels can't be managed on dietary modification alone.
Vit d levels are very low
(Injectibles will be a better option)
For iron and vit b12, oral medication will help
Kindly consult on practo app
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Dr. Ankita Gahlot
Obstetrician
12 yrs exp
Bangalore
Your haemoglobin, B12, and vitamin D levels are low enough to need proper treatment, not diet changes alone. This isn't something to manage without medical guidance.
Next Steps
See a physician who can decide whether oral supplements are enough for you or whether you need additional treatment.
Health Tips
Vegetarian sources like lentils, dairy, and fortified foods help, but at these levels they can't replace supervised treatment.
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