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Vitamin B12 deficiency can manifest in the following clinical conditions: - hyperchromic macrocytic megaloblastic anaemia (pernicious anaemia, Biermer's anaemia, Addison's anaemia), - funicular spinal disease

In cases of diagnostic uncertainty, additional tests such as holotranscobalamin or methylmalonic acid may be considered

USG abdomen showed bilateral mild pleural effusion

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In a study of patients with chronic low back pain, Vitamin B12 given for 2 weeks reduced pain by 32% compared to placebo [Chiu, 2011] In a 2020 systematic review looking at the use of B12 for nerve-related pain it was found that there is moderate evidence for the therapeutic effect of B12 in the treatment painful peripheral neuropathy [Julian, 2020]
