- Production of red blood cells (RBCs).
- Growth and development of children.
- Maintenance of the nervous system.
- Age over 40.
- Stomach surgery, stomach cancer, or gastritis.
- Diabetes and autoimmune disorders.
- Myxedema, Graves' disease, or other thyroid disorders.
- Genetic factors, such as in people of Northern European ancestry. It is rare in blacks and Asians.
- Family history of pernicious anemia.
- Strict vegetarian diet or infants breast-fed by a mother on a strict vegetarian diet.
- Lack of stomach acid in older adults.
- Parasitic infections and intestinal diseases.
- Some drugs such as H2 blockers, proton pump inhibitors, colchicine, neomycin, and aminosalicylic acid.
- Weakness, especially in the arms and legs.
- Sore tongue.
- Nausea, appetite loss, and weight loss.
- Numbness or tingling in the hands and feet.
- Difficulty maintaining proper balance.
- Pale lips, tongue, and gums.
- Yellow eyes and skin.
- Bleeding gums.
- Shortness of breath.
- Depression, confusion, poor memory, and dementia.
- Ringing in the ears (tinnitus).
- Complete blood count.
- Measurement of serum holotranscobalamin II.
- Reticulocyte count.
- Serum LDH.
- Serum methylmalonic acid (MMA) level.
- Serum vitamin B12 level.
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