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Haematological symptoms often appear first and include: Persistent tiredness and weakness that doesn't improve with rest Breathlessness, even with minimal exertion Pale or jaundiced (yellowish) skin Heart palpitations or rapid heartbeat Neurological and cognitive symptoms may develop alongside or independently of anaemia: Pins and needles sensation (paraesthesia), typically in hands and feet Difficulty walking or problems with balance Memory problems or difficulty concentrating Mood changes, including depression or irritability Glossitis (sore, red tongue) or mouth ulcers In severe or prolonged deficiency, more serious neurological complications can occur, including peripheral neuropathy, subacute combined degeneration of the spinal cord, and cognitive impairment

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These methods can help sustain adequate B12 levels and are often more convenient for long-term use