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There are some differences in the possible significance of blood testing for these vitamins in people with Down syndrome compared to people without Down syndrome

Persistent tiredness and fatigue Weakness or muscle fatigue A pale or slightly yellow tint to the skin A sore or inflamed tongue Pins and needles or numbness in the hands or feet Difficulty with memory or concentration Low mood or irritability Who Needs a Vitamin B12 Injection

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Sun Y et al., Clin J Pain 2013 Methylcobalamin for diabetic neuropathy

Vitamin B12 injections for deficiency are commonly hydroxocobalamin in the UK

the clinical relevance of this finding in humans is unknown, and in UK and EU prescribing information this is noted as a precaution rather than a formal contraindication but individuals with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN2) should discuss this with their doctor