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Qian Y, Pomeroy ML, Petchler CM

Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (which can be caused by ingestion of corrosives, extensive tumors, and conditions associated with gastric atrophy, such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy) Structural lesions leading to vitamin B 12 deficiency, including regional ileitis, ileal reactions, and malignancies Competition for vitamin B 12 by intestinal parasites or bacteria

This is because they have less body strength and may have other health problems

By walking patients through contraindication screening, you identify patients who should not receive the injection (allergies, uncontrolled hypertension, pregnancy) before harm occurs