• 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