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Description
The diagnostic process typically involves: Clinical history taking, focusing on symptoms (fatigue, neurological changes, dietary habits) Physical examination for signs of anaemia or neurological impairment Blood tests including full blood count, serum B12, and often folate levels Additional investigations such as intrinsic factor antibodies or parietal cell antibodies if pernicious anaemia is suspected For borderline results, additional tests like holotranscobalamin (active B12) may be considered NICE guidance recommends that treatment should commence based on clinical presentation if neurological symptoms are present, without waiting for laboratory confirmation, as delays can result in irreversible nerve damage
It has also shown promise in reducing symptoms of depression and anxiety, contributing to overall mental health
The documented protocol starts at 2.5 mg once weekly as a tolerability dose, then titrates up roughly every four weeks 5, 7.5, 10, 12.5, up to a 15 mg maximum maintenance dose
Accuracy matters more than convenience at this stage
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Metformin and B12 One of the most clinically important causes of B12 depletion
