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A count of blood cells in a patient with kidney disease may reveal reduced numbers of red blood cells (anemia) due to decreases in production of the hormone erythropoietin or may show blood concentration/dehydration due to the kidneys inability to prevent water loss (Ferri 2014a)

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At the cellular level, B12 acts as a cofactor for two critical enzymatic reactions: Methionine synthase converts homocysteine to methionine, essential for DNA methylation and synthesis Methylmalonyl-CoA mutase involved in fatty acid metabolism and myelin production By restoring adequate B12 levels, injections enable normal red blood cell maturation in the bone marrow, correcting the megaloblastic anaemia