'Mobile phone sign' in early vitamin B12 deficiency.

5. Isbister GK, Gray MR. White-tail spider bite: a prospective study of 130 definite bites by Lampona species. 'Mobile phone sign' in early vitamin B12 deficiency Sir, I greatly enjoyed the letter from Kozak and Schattner regarding 'Mobile Phone Sign' in early vitamin B12 deficiency. 1 I would, however, like to make one comment. I note that the patient reported in the letter was treated (successfully) with vitamin B12 injections, which he continues to receive monthly. In patients such as this, where the aetiology is dietary deficiency of B12, rather than pernicious anaemia or other gastrointestinal pathology, the physiological mechanisms for absorption of B12 should remain intact. Thus oral, rather than parenteral, replacement of B12 may well suffice. Obtaining suitable oral preparations is often difficult, but many years ago (as a Senior House Officer at St George's Hospital in London) I was taught a trick that proved effective in a vegan patient who had presented with very severe macrocytic anaemia. We supplied the patient with ampoules of B12, gave instructions as to how to open the ampoules, and advised him to sprinkle the contents into a meal on a weekly basis. This was effective, despite obvious concerns as to 'bio-availability'. Reference 1. Kozak N, Schattner A. 'Mobile phone sign' in early vitamin B12 deficiency.