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Older adults: Age-related changes can reduce the stomachs ability to absorb B12 from food

Recovering from illness or surgery , or if you get sick often

This typically involves: Intrinsic factor antibodies (highly specific for pernicious anaemia, though sensitivity is only 50%) [12] [28] Gastric parietal cell antibodies (more sensitive but less specific) Coeliac serology if malabsorption is suspected Consideration of upper gastrointestinal endoscopy in selected cases, particularly with autoimmune gastritis/pernicious anaemia NICE guidance emphasises that treatment should not be delayed whilst awaiting antibody results if clinical features strongly suggest deficiency, as irreversible neurological damage can occur

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For acute pain crises, cortisone may still be the pragmatic choice

See to it that the syringe chosen can properly measure and deliver the required dose