Culture and diversity

April 2010


Vitamin B12 deficiency

Why refugee patients are at high risk

Volume 39, No.4, April 2010 Pages 215-217

Jill Benson

Toni Maldari

Thomas Turnbull


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.

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

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