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Its deficiency can lead to a specific type of anemia called megaloblastic anemia, characterized by the production of abnormally large and dysfunctional red blood cells

Oral B12 supplementation (1,000-2,000 mcg daily sublingual methylcobalamin) can replicate the B12 component of MIC injections and is effective for most patients without malabsorption issues

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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

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for example, isoniazid, cycloserine, penicillamine, and hydralazine each form complexes with B or otherwise interfere with B metabolism, potentially leading to deficiency and peripheral neuropathy