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WHAT WE LEARNED By depleting B vitamins by preventing absorption or increasing excretion, some of the most common medications may put you at risk for deficiency

Earlier studies suggested that PA was restricted to Northern Europeans, but subsequent studies indicate that PA affects virtually all ethnic groups.37 Pernicious anaemia was considered a classical cause of vitamin B 12 deficiency before food-cobalamin malabsorption was described, and accounted for 15% to 25% of vitamin B 12 deficiency in the elderly in studies.9 In a local study on 296 Chinese patients, definite PA was diagnosed in 61% of patients having megaloblastic anaemia with vitamin B 12 or folate deficiency.38 Pernicious anaemia is characterised by destruction of gastric mucosa, especially fundal mucosa, primarily by a cell-mediated mechanism.39 There is progressive destruction and eventual loss of intrinsic factor producing gastric parietal cells

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This safety advantage has made patches the preferred delivery method for many prescriberswhich means the shortage is hitting the formulation that clinicians most want to prescribe