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It has also been linked to low stomach acid and gastritis, each associated with decreased iron absorption and lower iron levels

However, in patients with pernicious anaemia or malabsorption, these stores cannot be replenished through diet, making regular injections essential

Avoid touching, pressing, or massaging the treated area

Such complaints have been described in literature from 1900 onwards and may precede abnormal blood counts

Alternatively, the diagnostic criteria used to identify inadequate B12 status have been based on a known relationship between the serum B12 biomarker and low body stores, functional impairment, or clinical signs of deficiency