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GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count – to identify macrocytic anaemia Serum B12 and folate levels – to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine – when B12 results are borderline Intrinsic factor antibodies – if pernicious anaemia is suspected Additional tests – depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord
