- Knowledge deficit amongst physicians and other health care providers
- Poor or absent screening in symptomatic and at-risk patients
- Current range for “normal” serum B12 test extends far too low
- Lack of use of other sensitive tests to aid in diagnosis (methylmalonic acid)
- Clinicians wait for enlarged red blood cells or macrocytic anemia to be present
- Elderly are frequently misdiagnosed due to increased incidence of preexisting diseases and comorbid conditions
- B12 screening not included in older adults who fall or are at risk for falling
