Your body does not make vitamin B12 on its own, so you have to consume food and drinks that have vitamin B12 in order to get it. The anemia is macrocytic (mean corpuscular volume 100-150 fl or more); mild macrocytosis may be the earliest evidence of a megaloblastic process, but because of longevity of red cells, there is a gradual shift in mean corpuscular volume as comingling occurs with older normocytic red cells. However, as ever more sensitive methods were developed to assess subtle degrees of deficiency of the vitamin,4,5 it became clear that the effects of B12 deficiency were not restricted to the hematopoietic system but were often overshadowed by neurological complications and were sometimes entirely absent.6 Just as folate deficiency is associated with effects beyond anemia,7 B12 deficiency also can be associated with nonhematological complications, including increased risk of neural tube defect pregnancy, cognitive impairment, osteopenia, and vascular occlusive disease, perhaps attributable to the accumulation of homocysteine (Hcy) that occurs in B12 deficiency.3 Even so, because the most conspicuous manifestations of established B12 deficiency affect the blood and bone marrow and are a leading cause of macrocytic and megaloblastic anemia, it is ultimately the practicing hematologist who remains front and center of the clinical diagnosis and management of patients with suspected or confirmed B12 deficiency. Before Two clear examples of what influences the clinical presentation in a given patient are the rate of development and the degree of severity of deficiency. The diagnosis of vitamin B12 deficiency is based on blood tests. Your body absorbs only as much as it needs, and any excess passes through your urine. Zibold J, von Livonius B, Kolarova H, Rudolph G, Priglinger CS, Klopstock T, Catarino CB. Vitamin B12 is found in animal products you eat and drink such as meat, dairy and eggs. Several parameters of innate and acquired . For diagnostic purposes, the so-called blocking type, directed against the B12 binding site, is measured, as this type not only is highly specific for pernicious anemia but also is the species present in 70% of patients.96 Antibodies to parietal cells, although present in 90% of patients with pernicious anemia, are less specific, as they can occur in simple atrophic gastritis and in autoimmune thyroid disease.97. Erkurt MA, Aydogdu I, Dikilita M, Kuku I, Kaya E, Bayraktar N, Ozhan O, Ozkan I, Sonmez A. Med Princ Pract. Get useful, helpful and relevant health + wellness information. National Library of Medicine Undiagnosed or untreated, these conditions ultimately advance to a level of depletion of B12 that manifests the clinical features of B12 deficiency, either hematological or neurological or both. We have therefore performed a study to determine the prevalence of folate deficiency, vitamin B12 deficiency and hyperhomocysteinemia in 64 healthy men aged between 50 and 70 years, and . 2022 Nov 2;14(21):5401. doi: 10.3390/cancers14215401. Symptoms of CML include excessive fatigue, unintended or unexpected weight loss, fever, night sweats, pain or a feeling of fullness below the left-hand ribs. American Family Physician. There are several causes and varying degrees of severity of B12 depletion leading to deficiency (Table 1). Vitamin B12 deficiency anemia describes when a lack of vitamin B12 affects the production of healthy red blood cells. More severe side effects of vitamin B12 deficiency include: Untreated vitamin B12 deficiency can lead to severe neurological (nervous system) damage, which can put an individual at a higher risk of mortality. B12 deficiency is the leading cause of megaloblastic anemia, and although more common in the elderly, can occur at any age. Specific causes of lymphocytosis include: Acute lymphocytic leukemia. It can be treated with vitamin B12 medications. As a consequence, it is a micronutrient that is often in critically short supply, particularly among vegetarian or vegan populations who, through culture, poverty, or conviction, subsist on diets that lack or are poor in B12. If the vitamin B12 deficiency is caught early, most people are able to get rid of their symptoms with treatment. B12 deficiency can cause a variety of symptoms, including fatigue, headaches, depression, pale or yellow skin, mental impairment, and pain and inflammation in the mouth and tongue. Although the cause of requests was deficiency suspicions, an important ratio of high levels of Vitamin B12 were reported to physicians by laboratory. Dizziness, anxiety, headache and nausea are potential signs of elevated B12 levels, Mayo Clinic reports. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953733/), Visitation, mask requirements and COVID-19 information. Bethesda, MD 20894, Web Policies It is found in some fermented foods, such as tempeh and more commonly in nori and nutritional yeast (or yeast extract like Marmite). Epub 2008 Feb 19. In the small intestine, food B12 and biliary B12 are released from HC by pancreatic proteases and bind to intrinsic factor (IF). Many of the . Unable to load your collection due to an error, Unable to load your delegates due to an error. According to WebMD, potential but unlikely side effects of B12 injections include muscle cramps, weakness and irregular heartbeat. Unauthorized use of these marks is strictly prohibited. The best known of these is concomitant iron deficiency, which can mask the macrocytosis typically seen in B12 deficiency. Federal government websites often end in .gov or .mil. Failure to diagnose B12 deficiency can have dire consequences, usually neurological. HHS Vulnerability Disclosure, Help The site is secure. Vitamin B12 - otherwise known as cobalamin - is a water-soluble vitamin found in animal by-products, such as meat, fish and dairy. Their levels are high in >90% of B12-deficient patients and increase before serum B12 falls to subnormal levels.4,5 Even when there is no manifest evidence of clinical B12 deficiency, and serum B12 levels are not low, elevated levels of MMA and Hcy can be considered as sensitive biomarkers of a subclinical underlying state of B12 deficiency, which may potentially progress to a state of manifest B12 deficiency with its attendant clinical complications that may remain subtle, often being only neurological84 or may become more exuberant.3,85,86 MMA measurements can be carried out on either plasma or serum, whereas Hcy is best measured in plasma, because cellular release of Hcy in a clotted blood sample can alter Hcy levels.87,88 Elevated plasma MMA and/or elevated Hcy are both indicators of B12 deficiency in patients without impaired renal function or an inherited defect in cobalamin processing enzymes.4,13,14,89 Of the 2, MMA measurement is both more sensitive and more specific, and elevated MMA will persist for several days, even after B12 treatment. Vitamin b12 level seems fine by lymphocyte % is high @ 53.3%. Vitamin B12 is one of the eight B-vitamins that the human body uses for various important physical processes. Researchers have developed a new test to detect the levels of vitamin B12 using your breath, allowing for a cheaper, faster, and simpler diagnosis that could help to avoid the . 2002 Mar 9;146(10):459-64. High homocysteine levels usually indicate a deficiency in vitamin B-12 or folate. In most instances, however, it would be prudent to top up a B12-deficient patient through parenteral injection before switching to the oral route for maintenance, with due vigilance concerning compliance, particularly in the elderly. All megaloblastic anemias display similar clinical features. Copyright 2023 by American Society of Hematology, https://doi.org/10.1182/blood-2016-10-569186, 1. "Journal of the American Society of Hematology"; Serum Concentrations of Vitamin B12 in Patients Suffering from Leukemia; Marion F. Beard, et al. Some important principles need emphasizing. . He prescribed me Omeprazole, Clarithromycin, and Amoxicillin and I took five shots of vitamin B12. Elucidation of the physiology of B12 and its intricate mechanism of assimilation made it clear that there was a myriad of causes of B12 deficiency.3. Have attached report for reference. Ratios of values of high Vitamin B12 among test request in adults are reported as 14- 20% in present three monocentre studies and one multicentre study. Were it not for efficient conservation of biliary B12 through enterohepatic reabsorption,9-11 symptomatic B12 deficiency would occur more frequently among vegans. Module 7 - Care of the Adult with Hematologic Disorders Human Immunodeficiency Virus Infection (HIV) o Retrovirus that causes immunosuppression making persons more susceptible to infections o Depletes helper T cells, CD4 cells, and macrophages More than 1 million currently living with HIV About 50,000 new infections occur in United States each year Effective . Mild to moderate malabsorption (impaired ability to render food B, b. I think it's due to vitamin deficiency. Approximately 1.5% to 15% of people have vitamin B12 deficiency. Almeida I, Silva SV, Fonseca AR, Silva I, Vasconcelos C, Lima M. Clin Rev Allergy Immunol. Your doctor may order the test . Cinemre H, Serinkan Cinemre BF, ekdemir D, Aydemir B, Tamer A, Yazar H. J Investig Med. People who are 60 years old or older are more likely to have vitamin B12 deficiency compared to other age groups. Vitamin B12 deficiency is a treatable condition that happens if you are not consuming enough vitamin B12 in your diet or if your body is not absorbing it properly. Unable to load your collection due to an error, Unable to load your delegates due to an error. This activity will highlight the mechanism of action, adverse event profile, and other key factors . Do we need to reconsider the desirable blood level of vitamin B12? The richest sources are liver, clams, kidneys and oysters. An official website of the United States government. The IF-B12 complex then binds to the cubam (Cubilin [Cub]amnionless [Amn]) receptor in the terminal ileum for internalization and release to plasma where it is bound by TC. Regarding prevention of B12 deficiency, the Institute of Medicine Food and Nutrition Board has defined the RDI for adults at 2.4 g daily but with the caveat that individuals 51 years and older obtain most of this amount through consuming foods fortified with B12 or in a B12-containing supplement.8 This rider is added in consideration of the high prevalence of food B12 malabsorption caused by gastric dysfunction among the elderly. https://www.ncbi.nlm.nih.gov/books/NBK441923/. Ankar A, Kumar A. Vitamin B12 deficiency. 2015 Dec;49(3):347-69. doi: 10.1007/s12016-015-8505-8. Mild deficiency usually results from failure to render food B12 bioavailable or from dietary inadequacy. Basically, your body needs this vitamin to stay healthy. Epub 2007 Nov 9. Clipboard, Search History, and several other advanced features are temporarily unavailable. Among human leukocytes, CD8-positive lymphocytes have a relatively high density of vitamin D receptors 70,71, and the primary effect of vitamin D treatment involves changes in gene expression 29,70. Vitamin B 12 deficiency. Result: Experiencing a change in the way you feel and behave. High percentage of regulatory T cells before and after vitamin B12 treatment in patients with pernicious anemia. An autoimmune disorder causing ongoing (chronic) inflammation. Increasingly, holoTC measurement is being used for clinical assessment of B12 status, either singly3,76,77 or in combination with the total serum B12 with or without measurement of the metabolites MMA and Hcy.78-80 In addition, holoTC levels also reflect B12 absorptive capacity.81-83, Because they are the substrates of the 2 B12-dependent reactions, elevated levels of MMA and Hcy are sensitive indicators of tissue B12 deficiency. Vitamin B12 deficiency affects between 3% and 43% of older adults. Megaloblastic features in the granulocyte precursors consist of giant metamyelocyte and band forms containing large horseshoe-shaped nuclei (Figure 2). B12 deficiency is best diagnosed using a combination of tests because none alone is completely reliable. Vitamin B12 deficiency: Neutropenia could cause issues in the mouth including ulcers and abscesses (Image: Getty Images) Neutropenia happens due to the neutrophils being used up or being destroyed . The product, S-adenosyl-homocysteine (SAH), undergoes reversible hydrolysis by the enzyme adenosyl-homocysteine hydrolase (AHCY hydrolase), yielding Hcy and thus completing the methionine or remethylation cycle. This dramatic breakthrough was an enormous stimulus to hematologic investigation. A quest for the active principle in liver that made it possible to cure pernicious anemia ushered in the era of Big Pharma in a race to identify and produce the compound that ultimately became known as vitamin B12. [Hypervitaminosis B12 - a new marker and predictor of prognostically unfavorable diseases]. Lymphocytes. Vitamin B 12 deficiency is a serious health problem that can result in megaloblastic anaemia, inhibition of cell division, and neurological disorders.3 Folate deficiency can also cause megaloblastic anaemia and, although a high folate intake may correct anaemia from a vitamin B 12 deficiency, subtle neurological symptoms driven by the vitamin B 12 deficiency may arise. It can come from a lymphatic failure or a viral or bacterial infection and usually presents symptoms such as fever, general malaise, and sore throat. The normal values for vitamin B12 are anywhere between 200 and 900 pg/mL; different laboratories may have some variation in what level is considered normal. ; November 1953, Office of Dietary Supplements: Vitamin B12, Mayo Clinic; Chronic Myelogous Leukemia; October 2010, MedlinePlus; Vitamin B12 Level; March 2010. Additionally, vitamin B12 values of 13 acute lymphoblastic leukemia patients at diagnosis time were retrieved to enlighten possible role of lymphocytes. These results indicate that vit.B12 might play an important role in cellular immunity, especially relativing to CD8+ cells and the NK cell system, which suggests effects on cytotoxic cells. When high doses of vitamin B12 supplements are taken, symptoms due to anemia tend to resolve. While low serum cobalamin levels do not necessarily imply deficiency, an abnormally high serum cobalamin level forms a warning sign requiring exclusion of a number of serious underlying pathologies. In an adult, the total body B12 store is 3 to 5 mg, and the recommended daily intake (RDI) is 2.4 g.8 Natural food sources of B12 are restricted to food of animal origin. Having a difficult time walking or speaking like you usually do. If neurological problems develop from vitamin B12 deficiency, they may not be reversible. National Library of Medicine According to the Office of Dietary Supplements, your body uses vitamin B-6 to . Disclaimer. Thrombocytopenia may be severe, when it may be confused with thrombotic thrombocytopenic purpura.27,28 Platelet production is reduced to 10% of what would be expected from the megakaryocyte mass,29 reflecting ineffective thrombopoiesis, and platelets may be functionally abnormal.30, Cytogenetic changes, when they occur, are nonspecific and show elongated and broken chromosomes, changes that are usually corrected within 2 days of treatment, although some abnormalities may remain for months.21,31, What determines the particular manifestations of B12 deficiency in a given individual depends on several factors, some of which are understood, others not. Epub 2022 Jul 22. It has been suggested that vitamin B12 (vit.B12) plays an important role in immune system regulation, but the details are still obscure. Supply of folic acid to a B12-deficient patient can intermittently bypass this block through reduction of folic acid to dihydrofolate and then tetrahydrofolate, thereby partially or temporarily alleviating the anemia. Iron, vitamin B12, or folate deficiency; bone marrow damage; leukemia or lymphoma; acute or chronic blood loss; red blood cell hemolysis Dehydration, renal problems, pulmonary disease, congenital heart disease, polycythemia vera Mean corpuscular volume (MCV) Average size of red blood cells 80-95 fL Iron deficiency Vitamin B12 or folate deficiency Langan RC, Goodbred AJ. Clinical Medicine. 6 A previous study also showed that vitamin B12 could suppress viral replication in the host cells. Because the passive route of absorption of B12 applies to all mucosal surfaces, approved sublingual and intranasal formulations of B12 are also available. Present when you have folate or vitamin B12 deficiency. It can also be caused by a vitamin deficiency, though not generally as a result of a B-12 deficiency. The normal values for vitamin B12 are anywhere between 200 and 900 pg/mL; different laboratories may have some variation in what level is considered normal. 1 Latin . HHS Vulnerability Disclosure, Help B12 also works with other B vitamins to improve certain functions. MeSH MeSH The body needs vitamin B12 to make red blood cells. An abnormally high or low amount of vitamin B12 can indicate a potential disorder. . This element is necessary for many physiological reactions, especially in the cardiovascular and respiratory systems. (B) A megaloblastic (giant) granulocyte precursor. Vitamin B12 is an important nutrient that helps your body make red blood cells and DNA, the genetic material in all of your cells. Vitamin B12 is then able to be absorbed by your digestive system. Keywords: Hypercobalaminemia (high serum vitamin B12 levels) is a frequent and underestimated anomaly. If not intact, then the choices lie between intramuscular injection of 1000 g B12 (cyanocobalamin in the United States; hydroxocobalamin in Europe) given every other day for 1 to 2 weeks followed by weekly injections for a month and then tapered to once a month indefinitely. All formed blood elements are affected by the ineffective megaloblastic hematopoiesis, but erythrocytes show the most marked changes, both in size and in shape, with large oval macrocytes and prominent anisopoikilocytosis. You get this vitamin from eating foods such as meat, poultry, shellfish, eggs, and dairy products. An understanding of the normal physiology and its perturbations in disease is a key factor to the understanding of the causes and manifestations of B12 deficiency. There is a preponderance of basophilic erythroblasts over more mature hemoglobinized forms, creating the appearance of a maturation arrest. Because B12 deficiency is amenable to simple replacement therapy, diagnosis is critical. Children did not have any malign or chronic diseases causing the high Vitamin B12 values. In all 11 patients and eight control subjects, these immune parameters were evaluated before and after methyl-B12 injection. It can also be found in fortified foods (foods that have certain vitamins and nutrients added to them) such as certain cereals, bread and nutritional yeast. Dietary vitamin B12 deficiency usually results from inadequate absorption, but deficiency can develop in vegans who do not take vitamin supplements. Pearls and pitfalls in nonalcoholic fatty liver disease: tricky results are common. The lymphocyte counts and number of CD8+ cells increased both in patients and in control subjects. Ter Arkh. Liver and kidneys, especially from lamb, are rich in vitamin B12. The causes that are listed as severe usually involve disease processes that disrupt some aspect of the physiological pathway for B12 absorption comprising intrinsic factor and the cubam receptor in the terminal ileum. Please enable it to take advantage of the complete set of features! Only 10% of each B12 dose is retained. There are many other causes of B12 deficiency, which range from severe to mild. Vitamin B12 as an immunomodulator can regulate cellular immune responses and can also support hematopoiesis. The morphologic features of megaloblastic anemia may be grossly exaggerated in splenectomized patients or in whom there is functional asplenism as occurs in celiac disease or sickle cell anemia when circulating megaloblasts and bizarre red cell morphology may be present.24. Both human and animal studies have shown that vitamin B12 deficiency is associated with altered lipid profile and play an important role in the prediction of metabolic risk, however, as of . doi: 10.7759/cureus.31936. PMC Glutathione. Hepatitis A. Accessibility The high frequency of high serum cobalamin was recently exemplified in a retrospective study by Deneuville et al., which included 3702 hospitalized patients in whom high levels of vitamin B12 were found in 12% of cases, whereas a deficiency was only observed in 10% of cases. Typically, B12 levels are measured with a complete blood count or CBC test. Having a hard time remembering things or getting confused easily. Food B12 is released in the stomach and binds to salivary HC. TC delivers B12 to the TC receptor (CD320) on cells, and following release in the cell, B12 is reduced and converted to adenosylcobalamin in the mitochondria and methylcobalamin in the cytosol, where they serve as cofactors for the 2 B12-dependent reactions. . No biological basis for this apparent increased requirement for B12 replacement is known, but because there are no reports of adverse effects associated with excess B12 intake, there is no reason to advise against this practice.8. High lymphocytes count known as a lymphocytosis, it . Between 1% and 4% of an oral dose of B12 is absorbed passively, even when the intrinsic factor-dependent pathway is abrogated.102 Consequently, oral replacement therapy with B12, which was used successfully in the past,103 has again come into vogue,104 because of convenience and cost. Polymorphic differences in genes involved in the complex repertoire that comprises the pathways of B12 absorption, assimilation, cellular metabolism, and plasma transport of the vitamin (Figure 1) are known to affect the susceptibility to develop B12 deficiency.32,33 Whether these genetic factors can also influence the disease phenotype in B12 deficiency is not well understood at this time. Anisocytosis becomes more marked, and the earliest measurable change in red cell indices is an increase in the red cell distribution width. Timely diagnosis is important, and treatment is gratifying. - confirm blood film of iron deficiency and thallasemia can look very similar. In a large study of smokers (almost 30,000 people), lower initial vitamin B12 levels were associated with a 5.8-fold higher risk of getting stomach cancer (gastric carcinoma).The association remained even >10 years after blood collection. Next, vitamin B12 combines with something called intrinsic factor, a protein made by your stomach. But other research shows that the risk of cancer is higher in people with low levels of vitamin B12 or . Doctor told me that chest x-ray report is good and he just told I have low vitamin B12 level and I have bacteria in stomach. (A) Megaloblastic change in the nucleus of an erythroid precursors consisting of variegated finely granular chromatin (salt-and-pepper appearance) in contrast to the ground-glass texture of normal proerythroblasts. Diagnosis of vitamin B12 deficiency in patients with myeloproliferative disorders. Clipboard, Search History, and several other advanced features are temporarily unavailable. Would you like email updates of new search results? Because of the often conspicuous hematological manifestations of B12 deficiency, it remained largely within the domain of hematology. MeSH A severe vitamin B12 deficiency may damage nerves, causing tingling or loss of sensation in the hands and feet, muscle weakness, loss of reflexes, difficulty walking, confusion, and dementia. Could the high count be a . Neutrophils typically show hypersegmentation of their nuclei, beyond the usual 3 to 5 lobes, and may contain 6 or more lobes.25 Hypersegmented neutrophils are an early sign of megaloblastosis and may persist for many days after treatment.25 However, neutrophil hypersegmentation does not appear to be a sensitive indicator of mild B12 deficiency.26 Leukopenia and thrombocytopenia may be present but only rarely cause clinical problems. Without enough red blood cells, your tissues and organs don't get enough oxygen. Left untreated, CML may progress to bone marrow failure, bleeding and infection. The amount of vitamin B12 babies and children need varies based on age. Vitamin B12 deficiency can be spotted by the symptoms its deficiency shows. Unauthorized use of these marks is strictly prohibited. doi: https://doi.org/10.1182/blood-2016-10-569186. Before The .gov means its official. The most common example is chemotherapy treatment. Please enable it to take advantage of the complete set of features! Unable to load your collection due to an error, Unable to load your delegates due to an error. Vitamin B12 deficiency anemia happens when your body does not have enough healthy red blood cells because your body has a vitamin B12 deficiency. An abnormally high or low amount of vitamin B12 can indicate a potential disorder. These entities are essentially comprised of solid neoplasms, haematological malignancies and liver and kidney diseases. Vitamin B1 has been shown to help improve energy levels, and thus can help people with Lyme disease combat chronic fatigue. doi: 10.1002/pul2.12173. Red blood cells carry oxygen around the body using a substance called haemoglobin. NCI CPTC Antibody Characterization Program. Having an excessively high or extremely low amount of vitamin B12 in your system can indicate a potential health problem; one of the diseases linked to B12 levels is a form of leukemia called chronic myelocytic leukemia. In addition to the ineffective erythropoiesis caused by intramedullary apoptosis of megaloblastic erythroid precursors,20 the erythrocytes that are produced have increased rigidity associated with abnormal red cell membrane proteins leading to shortened red cell survival.56,57 The resulting hemolysis is associated with a 30% to 50% reduction in red cell lifespan. I. In this proposed mechanism, chronic Helicobacter pylori infection may, through molecular mimicry of H+K+ ATPase, evoke a host immune response that involves CD4+ T cells through a Fas-dependent mechanism37 and leads to destruction of the gastric mucosa.38,39, Nutrient-nutrient interactions are known to play a role in the manifestations of B12 deficiency. In B12 deficiency, there is disruption of normal folate cycling for regeneration of methylene-tetrahydrofolate, the form required to sustain synthesis of thymidine for DNA replication. Leukemia is a cancer that affects either bone marrow or the white blood cells, the defenders of your immune system that help fight off infection. Normally, the major fraction (70% to 90%) of circulating B12 is bound to HC, which is unavailable for immediate delivery to cells. Vitamin B12 is mainly found in meat, offal, milk, fish and eggs. 2022 Oct 1;12(4):e12173. At least 3% of people aged 20 to 39 years old. Vitamin B12 deficiency is a treatable condition that happens if you are not consuming enough vitamin B12 in your diet or if your body is not absorbing it properly. Infants: breastfeeding in infants with vitamin B, Disruption of intrinsic factor/cubam absorption, Failure of gastric digestion and release of food B, Megaloblastic anemia and/or neurological complications, Megaloblastic anemia and serious neurological deficits rare; associated with more rapid cognitive decline, Responds to daily physiological dose supplements of oral B. This condition can greatly increase the amount of vitamin B12 in the patient's system, MayoClinic.com explains. Identification of Patients with Cobalamin Deficiency Crucially Depends on the Diagnostic Strategy. Pencil cells - iron deficiency anemias. Undisturbed maturation of the cytoplasm as hemoglobin forms in a cell with an immature-appearing nucleus results in cells that are conspicuous for their lack of synchrony between nuclear and cytoplasmic development. Effects of cyanocobalamin on immunity in patients with pernicious anemia. Eight B-vitamins that the risk of cancer is higher in people with levels... 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B12 as an immunomodulator can regulate cellular immune responses and can also support hematopoiesis by American Society of.! Released in the red cell indices is an increase in the elderly, can occur at any age to! Increased both in patients and in control subjects affects between 3 % of each B12 dose is retained reactions especially... Animal products you eat and drink such as meat, dairy and eggs render food B12 is found in,! All 11 patients and in control subjects only as much as it needs, and several other features! B12 bioavailable or from dietary inadequacy people who are 60 years old or are... Of people have vitamin B12 deficiency, though not generally as a result of a B-12 deficiency which can the. Of cyanocobalamin on immunity in patients with pernicious anemia deficiency would occur more frequently among vegans doi:.... Are several causes and varying degrees of severity of B12 applies to all mucosal,. 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