Australia takes about 13 000 refugees per year, about one-third each from Africa, the Middle East and the Asia/Pacific region.1 The majority have had diets of limited or no animal source foods (ASFs). Vitamin B12 is found in red meat, seafood, dairy products and eggs, and in fortified packaged cereals in developed countries.2 It is well established that vitamin B12 deficiency is a common problem in most of the developing world.3–5 Much of the world’s population consumes less than 20% of its energy from ASFs compared to wealthier nations where ASF intake comprises about 40% of energy consumption.5 Literature from countries such as Kenya, where many of Australia’s Sudanese refugees lived in refugee camps, confirm the paucity of ASFs in their diets and the low vitamin B12 levels in this population.3
Vitamin B12 is one of the most complex vitamins. The measurement of serum levels and
the significance of the results are much debated in the literature.
This article discusses testing for vitamin B12 deficiency, its clinical manifestations and
the possible repercussions for Australia’s refugee population.
Full blood count and blood film, iron studies and haemoglobinopathy studies are
routinely performed for newly arrived refugees in Australia. At the Migrant Health
Service in Adelaide, South Australia, a young woman was found to have a very unusual
blood picture with a normal mean cell volume, despite quite severe iron deficiency and
thalassaemia trait. Her vitamin B12 was found to be 75 pmol/L. The following week
there arose another case of an 11 month old breastfed baby with a vitamin B12 level
of 52 pmol/L, whose mother had a level of 300 pmol/L. Understanding the clinical
manifestations of vitamin B12 deficiency and how it is relevant to Australia’s refugee
population might assist to resolve some of the difficulties that refugees face in Australia.
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