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GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count to identify macrocytic anaemia Serum B12 and folate levels to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine when B12 results are borderline Intrinsic factor antibodies if pernicious anaemia is suspected Additional tests depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord

PMID 32376677

Individuals with certain genetic variations affecting methylation (such as MTHFR-related variations) may prefer to avoid cyanocobalamin since additional conversion is required

Grade II includes partial ligament tearing with moderate swelling, bruising, and some joint laxity