Many nutrients have their action INSIDE the cell, which means that testing serum and blood levels just give us an indication of what may be available but that is assuming everything else is working properly: cellular activity, enzyme activity, receptor activity, etc
Treatment considerations include: Concurrent folate supplementation if deficient (never give folate alone, as it may precipitate neurological deterioration) Potassium monitoring during initial treatment in severe anaemia or at-risk patients (e.g., those with heart failure) Response assessment: reticulocyte count peaks at 57 days, haemoglobin normalises within 68 weeks Neurological symptoms may take 612 months to improve and may not fully resolve Patients should be advised that treatment for pernicious anaemia or post-surgical deficiency is lifelong
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This pattern aligns with B12 pharmacokinetics: serum levels peak 8-12 hours post-injection, tissue saturation occurs over 48-72 hours (Andrs et al., Journal of Blood Medicine , 2018)
