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22,23 In patients with a normal or low-normal serum vitamin B 12 level, complete blood count results demonstrating macrocytosis, or suspected clinical manifestations, a serum methylmalonic acid level is an appropriate next step 1,2,6,18 and is a more direct measure of vitamin B 12 's physiologic activity

For maximum effect, we administer B12 injections on a weekly basis

Individual Deficiencies or Needs The specific health needs of an individual can greatly influence how effective these injections are

IV hydration may be discussed when dehydration or a broader supportive-care need is part of the visit

People with digestive conditions such as Crohn's disease, celiac disease, or other inflammatory bowel conditions often have a compromised gut lining and cannot absorb oral B12 efficiently