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10.1038/s41392-022-01257-8 50 WuX.WeiS.ChenM.LiJ.WeiY.ZhangJ.et al (2022b)

Contraindications include known hypersensitivity to any component of the injection (including cobalt hypersensitivity), a history of severe reactions to thiamine/pyridoxine/cobalamin injections, and Lebers hereditary optic neuropathy (for B12-containing products)

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Although one-third of patients with vitamin B12 deficiency can have normal serum B12 concentrations, measuring serum vitamin B12 is still a convenient screening test when the clinical picture is suggestive of vitamin B12 deficiency

In such cases, MMA concentrations in urine should be adjusted for creatinine excretion (Norman & Morrison, 1993) and the ratio of urinary MMA to creatinine (uMMA/C) applied to assess B12 status