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Pathological causes of elevated B12 warrant careful consideration: Haematological disorders : Myeloproliferative neoplasms (polycythaemia vera, chronic myeloid leukaemia), acute leukaemia, and lymphoproliferative disorders can increase B12-binding proteins (transcobalamin and haptocorrin), elevating total serum B12 [3] Liver disease : Hepatocellular damage releases stored B12 into circulation

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Management: Use cautiously and under medical guidance if prolonged therapy is needed

Enterohepatic Circulation Various studies have indicated that .1-.2% of the bodys B12 pool is lost per day