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Iron deficiency leads to smaller red blood cells, so a patient with both low levels of iron and B12 will be anemic, but not have macrocytic anemia

Pharmacokinetics: Cyanocobalamin is administered intranasally, orally, and parenterally, while hydroxocobalamin is administered only parenterally. Once absorbed, vitamin B12 is highly bound to transcobalamin II, a specific B-globulin carrier protein and is distributed and stored primarily in the liver as coenzyme B12. The bone marrow also stores a significant amount of the absorbed vitamin B12. This vitamin crosses the placenta and is distributed into breast milk. Enterohepatic recirculation conserves systemic stores. The half-life is about 6 days (400 days in the liver). Elimination is primarily through the bile; however, excess cyanocobalamin is excreted unchanged in the urine

Veganism or Vegetarianism Vitamin B12 deficiency is common among vegans because typical vitamin B12 sources (meat, yogurt, etc.) are simply not present in their diets

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