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Your IgM is elevated which is concerning for multiple myeloma or lymphoma however the remainder of your labs are not directly consistent with this

At these high doses, a small but consistent percentage of B12 is absorbed by passive diffusion, bypassing the intrinsic factor mechanism

The signs and symptoms of B12 deficiency that indicate you may benefit from vitamin B12 injections include: chronic fatigue, lethargy and weakness Muscle aches, joint pain and trouble exercising Poor memory, inability to concentrate and other cognitive problems associated with aging Mood changes, like increased depression and anxiety, or signs of nervousness like rapid heartbeats/palpitations Poor dental health, including bleeding gums and mouth sores Shortness of breath and feeling dizzy Poor appetite or digestive problems, like constipation, nausea, diarrhea or cramping Sometimes greater risk for problems like cardiovascular complications or even cancer (due to a rise in homocysteine levels) Why might you be low in vitamin B12, even if you eat a relatively healthy diet

Here are the most common signs of B12 deficiency: Physical symptoms You feel tired and lack energy