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According to British Society for Haematology (BSH) guidelines and NICE Clinical Knowledge Summaries (CKS), the primary beneficiaries include: Key patient groups who may require B12 injections include: Pernicious anaemia patients – requiring lifelong hydroxocobalamin 1mg intramuscularly every 2–3 months following initial loading doses Patients with gastrointestinal disorders – including those who have undergone gastrectomy or ileal resection, and patients with conditions affecting B12 absorption such as Crohn's disease or coeliac disease Strict vegans and vegetarians – though oral supplementation is usually sufficient unless malabsorption is present Elderly patients – who may have reduced gastric acid production affecting B12 absorption Patients taking certain medications – including metformin (MHRA advises monitoring B12 levels in long-term users, particularly those with risk factors or symptoms), proton pump inhibitors, and H2-receptor antagonists long-term [6] Individuals with neurological symptoms – such as paraesthesia, ataxia, or cognitive impairment related to B12 deficiency Pregnant women – with confirmed deficiency (hydroxocobalamin for malabsorption

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