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If left untreated, B12 deficiencies can cause other complications within the body and the digestive system

Fermentation by a variety of microorganisms yields a mixture of methylcobalamin, hydroxocobalamin and adenosylcobalamin

The United Kingdom National Quality Assessment Scheme for Haematinic Assays warns against false B12 results and the risk of neurological damage: In the event of any discordance between clinical findings of B12 deficiency and a normal B12 laboratory result, then treatment should not be delayed

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Other risk groups include older adults, pregnant women, people taking metformin or long-term acid-suppressing medications (PPIs, H2 blockers), those with conditions affecting the gastrointestinal tract (pernicious anaemia, Crohn's disease, coeliac disease), and individuals who have undergone gastric or ileal surgery