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We wish to acknowledge the Rodent In Vivo Assessment core (directed by Dr

Certain groups are at higher risk, including older adults (due to reduced stomach acid production), individuals with pernicious anaemia (an autoimmune condition affecting B12 absorption), those who have undergone gastrointestinal surgery, and people with conditions such as Crohn's disease or coeliac disease

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Patients should be referred urgently if they have neurological symptoms, if the diagnosis is unclear, or if there is inadequate clinical response to treatment

After reviewing literature and conducting a two-round Delphi survey with 42 experts, a consensus emerged that emphasizes prioritizing clinical symptoms in diagnosis, with serum B12 as a screening marker supported by methylmalonic acid or homocysteine levels for additional confirmation