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In the fourth and last stage of B12 deficiency, clinical manifestations are experienced by the individual including macrocytic anemia (a form of anemia in which red blood cells are larger than usual, hence the term macro) and, if left untreated, irreversible neurological damage
A deficiency can cause various health issues, including megaloblastic anemia and neurological changes
and a healthy 24-year-old medical student without any clinical or laboratory evidence of systemic disease
A more individualized response-based approach monitors body composition changes and continues therapy as long as positive progress occurs, adjusting or pausing when plateaus develop or goals are achieved
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