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Symptoms of vitamin B12 deficiency include: fatigue, irritability, anxiety, low energy, depression, forgetfulness, constipation, new food sensitivities, hot and cold flashes, sore muscles, pale skin, numbness, tingling, and dermatitis

Patients with persistent symptoms, including those with PTLD, have also been studied using various neuroimaging modalities including MRI (121, 122), SPECT (123, 124), and PET (125) scanning techniques

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Contraindications include active infection at the injection site, severe thrombocytopenia, or anticoagulation therapy requiring provider clearance