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[1] Specific situations warranting B12 testing include: Persistent unexplained fatigue or weakness Neurological symptoms such as numbness, tingling, or balance problems Cognitive changes or memory difficulties Following a diagnosis of autoimmune conditions (pernicious anaemia often coexists with other autoimmune diseases) Adherence to a strict vegan or vegetarian diet without supplementation Gastrointestinal disorders affecting absorption (Crohn's disease, coeliac disease, previous gastric surgery) Long-term use of medications that interfere with B12 absorption, including metformin (commonly prescribed for type 2 diabetes) and PPIs Unexplained macrocytic anaemia detected on routine blood tests Pregnancy, where prompt treatment of deficiency is important Urgent action is needed if you develop neurological symptoms such as significant paraesthesia, ataxia (poor coordination), gait disturbance, or cognitive changes

doi: 10.1111/j.1476-5381.1978.tb07786.x