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However a blood test is not mandatory to begin treatment if your symptoms and clinical history are consistent with deficiency

If you have a medical condition where you are unable to absorb sufficient B12 from your diet, an injection at least once a month is highly recommended in order to stay healthy

The Reconstitution Solvent: Choosing Wisely This is a major decision point

Some people on standard maintenance notice tiredness, brain fog or tingling creeping back well before the next injection is due

Common causes include liver disease (which releases stored B12), kidney disease (reducing B12 clearance), haematological malignancies, solid tumours, and excessive supplementation

For Vitamin D, the serum 25-hydroxyvitamin D test is recommended