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Also, megaloblastic anemia is a sign
Treatment should start urgently and should not be delayed for laboratory confirmation if neurological features strongly suggest B12 deficiency
While this idea is somewhat simplified, its intriguing His hypothesis suggests that the sudden influx of B12 can kickstart repair processes, and if there has been long-standing damage, the rapid onset of these processes might overwhelm the system, causing a temporary worsening of symptoms
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Persistent unexplained elevation alongside an abnormal CBC or differential, constitutional symptoms such as unexplained weight loss, night sweats, or persistent fever, or organ-specific findings all raise the need for referral
