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Vitamin B12deficiency can manifest itself in the following clinical pictures: Hyperchromic macrocytic megaloblastic anemia (perniciosa, Biermer anemia, Addison's anemia these are disorders of the maturation of red blood cells) Funicular spinal disease [damage to the spinal cord] A vitamin B12deficiencyconfirmed by laboratorydiagnosis can occur in: Years of malnutrition and malnutrition (e.g through strict vegetarian diet)

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These factors suggest starting slightly higher than the minimum effective clinical dose to account for real-world variability

Metabolism Individual metabolic rates can affect how quickly the body utilizes the vitamin