These include serious infection, uremia or renal failure, drugs with bone marrow suppression properties (e.g., chloramphenicol), or concurrent undiagnosed folic acid or iron deficiency anemia
A B12 deficiency can lead to anemia, which reduces the oxygen-carrying capacity of the blood, resulting in fatigue, weakness, and shortness of breath
This can give the skin and the whites of the eyes a mild yellow tint (jaundice)
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When high doses of vitamin B 12 are given orally, only a small percentage can be absorbed, which may explain the low toxicity (4)