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While a bone marrow biopsy was not conducted in this instance, it is generally not required for diagnosing vitamin B12 deficiency unless there is a concern for hematologic malignancies

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10.7860/JCDR/2022/53256.16055 48 Sanz-CuestaT.Escortell-MayorE.Cura-GonzalezI.Martin-FernandezJ.Riesgo-FuertesR.Garrido-ElustondoS.et al (2020)

Genetic variants (below) can also clue you in as to whether you may need more riboflavin than normal

What is vitamin B12 deficiency anemia

Oct 2014;86(10):1752-8
