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24 Table 3 Estimated Sensitivity and Specificity of Serum Laboratory Tests for Vitamin B12 Deficiency Pernicious anemia refers to one of the hematologic manifestations of chronic auto-immune gastritis, in which the immune system targets the parietal cells of the stomach or intrinsic factor itself, leading to decreased absorption of vitamin B 12
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This makes seniors particularly vulnerable to deficiency, which can contribute to cognitive decline, fatigue, and nerve damage
[16] Although cyanocobalamin lacks a defined upper-toxicity threshold due to its water solubility and renal elimination, exceptionally high cumulative doses have been temporally associated with acneiform eruptions, altered potassium homeostasis, and theoretical thrombotic risk, emphasizing the importance of evidence-based dosing
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