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NHS approach to B12 deficiency: NICE Clinical Knowledge Summaries recommend investigating B12 deficiency in patients presenting with macrocytic anaemia, unexplained neurological symptoms, or risk factors including pernicious anaemia, gastrectomy, malabsorption disorders, metformin use, proton pump inhibitors, or nitrous oxide exposure

Recommended Testing Schedule Heres a suggested testing plan for B12 treatment: First test B12 levels before starting treatment Check again after the first dose (usually 1-3 months later) Test every 3-6 months while taking maintenance doses Test more often if you have trouble absorbing B12 or other health issues Interpreting B12 Levels During Treatment When looking at B12 levels, doctors must think about a few things

Apply gentle pressure with a clean alcohol pad if any bleeding occurs (typically minimal to none)