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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


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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 of B12 remain publicly funded for those with evidence of malabsorption that are eligible for the Ontario Drug Benefit.



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