Skip to main content

Evidence to Improve Care

Testing Vitamin B12 Levels in Neuropathy, Alopecia, Dizziness, and Fatigue


Ontario Health Technology Advisory Committee Recommendations

  • The Ontario Health Technology Advisory Committee recommends serum vitamin B12 testing be restricted to those with macrocytic anemia or malabsorption.

  • The Ontario Health Technology Advisory Committee recommends against serum vitamin B12 testing for the purpose of investigating dementia or cognitive impairment and for vague presentations such as alopecia, dizziness, and fatigue.

Read the full OHTAC Recommendation report



Low levels of vitamin B12 in the body can lead to problems with the nervous system and to low iron in the blood. Neuropathy (diseases of the nervous system), alopecia (hair loss), dizziness, and fatigue (feeling tired) may be signs of these conditions.


Health Quality Ontario Reviews Testing Vitamin B12 Levels in Neuropathy, Alopecia, Dizziness, and Fatigue

Health Quality Ontario looked at whether people with neuropathy, alopecia, dizziness, and fatigue should be tested for low vitamin B12.


Testing Vitamin B12 Levels in Neuropathy, Alopecia, Dizziness, and Fatigue: A Rapid Review (PDF)
February 2014


Use of this site, and the interpretation of the information contained here, is subject to important terms and conditions. Use of this site and information except in accordance with these terms and conditions is expressly prohibited.


The Ministry of Health and Long-Term Care endorses this recommendation.

The Ministry of Health and Long Term Care has provided the following response: The Ministry removed the vitamin B12 test from the Ontario laboratory requisition form in November 2012. The test can still be requested if needed and remains an insured service with no restrictions on its use.
The Ministry agrees with the recommendation regarding oral vitamin B12 and notes that intramuscular injections remain publicly funded for those with evidence of malabsorption.




Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


RECEIVE NOTIFICATION OF WHEN OUR DRAFT RECOMMENDATIONS ARE OPEN FOR FEEDBACK

Sign up for our newsletter to receive monthly notifications of when draft recommendations are open for feedback

A senior couple looking at their tablet together

Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Claude Lurette and Kowsiya Vijayartnam, Health Quality Ontario Patient, Family and Caregiver Advisors Council Co-Chairs

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone