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Clinical Manifestations of Vitamin B12 Deficiency Although the classic hematologic expression of vitamin B 12 deficiency is a megaloblastic macrocytic anemia characterized by an elevated mean corpuscular volume and mean corpuscular hemoglobin, and a peripheral smear containing macroovalocytes and hypersegmented neutrophils, up to 28 percent of affected patients may have a normal hemoglobin level, and up to 17 percent may have a normal mean corpuscular volume

The hormone has far greater timeframe to circulate around the body, bind to receptors, and exert its effects

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gradual titration (4-week intervals) significantly reduced GI discomfort compared to rapid escalation [6]

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No significant organ toxicity has been observed in standard histological analyses of animals treated with therapeutic-range doses