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Further guidance on assessment and management of B12 deficiency is available via NICE Clinical Knowledge Summary (CKS): Anaemia B12 and folate deficiency

Symptoms of vitamin B12 deficiency: extreme tiredness a lack of energy pins and needles a sore and red tongue mouth ulcers muscle weakness problems with your vision psychological problems, which can range from mild depression or anxiety to confusion and dementia problems with memory, understanding and judgement Causes of a vitamin B12 deficiency: pernicious anaemia a lack of these vitamins in your diet medicine certain medicines, including anticonvulsants and proton pump inhibitors (PPIs), can affect how much of these vitamins your body absorbs

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The following may receive cyanocobalamin injections to treat and prevent B12 deficiency: People with pernicious anemia, a type of anemia in which there is lack of intrinsic factor, a natural substance that is required to absorb B12 from the intestines