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The diagnostic process typically involves: Clinical history taking, focusing on symptoms (fatigue, neurological changes, dietary habits) Physical examination for signs of anaemia or neurological impairment Blood tests including full blood count, serum B12, and often folate levels Additional investigations such as intrinsic factor antibodies or parietal cell antibodies if pernicious anaemia is suspected For borderline results, additional tests like holotranscobalamin (active B12) may be considered NICE guidance recommends that treatment should commence based on clinical presentation if neurological symptoms are present, without waiting for laboratory confirmation, as delays can result in irreversible nerve damage

Conversely, a few studies reported high levels of vitamin B12 in the blood of patients with a worse COVID-19 outcome 48,49 potentially due to cytolysis leading to the release of intracellular B12 into the plasma and disrupted B12 clearance by the liver, which is often affected in these patients 50

Pro-inflammatory T helper 17 directly harms oligodendrocytes in neuroinflammation

The typical Vitamin B12 dosage is 1000 mcg

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