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The BMJ clinical review notes that route selection should be based on the cause of deficiency rather than preference alone

Patients should be reviewed 812 weeks after commencing treatment to assess: Symptomatic improvement, particularly resolution of fatigue and neurological symptoms Haematological response (normalisation of haemoglobin and mean cell volume) Reticulocyte count typically rises within one week, indicating bone marrow response Repeat serum B12 testing is generally not useful after starting parenteral therapy, as levels remain elevated for months

thetaiotaomicron creates competition by using a surface-exposed lipoprotein, which binds cobalamin with such affinity that can remove it from intrinsic factor, a cobalamin transport protein necessary for absorption in humans and animals [14]