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Cause of Low B12 levels Pernicious anaemia vegan diet malabsorption syndromes coeliac sprue Crohn's ulcerative colitis (UC) "food-bound cobalamin malabsorption syndrome" predisposing factors include atrophic gastritis, long term proton pump inhibitor or H2 antagnoist use, chronic alcoholism, gastrectomy/gastric bypass surgery, pancreatic exocrine failure, AIDS myeloma (paraprotein related assay interference) pregnancy combined oral contraceptive pill/HRT pancreatric insufficiency metformin, acute phase situations
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Using sterile water beyond a single use or sharing it between patients can risk contamination, since it has no agent to suppress bacterial growth
An update on cobalamin deficiency in adults
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