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More than two thirds of the B 12 excreted in bile is reabsorbed in the small intestine, but this reabsorption is reduced in people with pernicious anaemia or other causes of B 12 malabsorption.5859 Nitrous oxide toxicity The Association of British Neurologists has recently issued guidance on recognising and managing nitrous oxide toxicity associated with B 12 deficiency.14 It recommends rapid initiation of alternate-day intramuscular hydroxocobalamin therapy, and maintenance of this treatment until all symptoms have resolved or there is no further neurological improvement, with long term B 12 therapy depending on the presence of deficiency on presentation, together with total abstinence from the use of nitrous oxide

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Among all patients receiving a blood transfusion, TRALI occurs in 0.0815%, with ICU patients having a 50100 times higher occurrence than general inpatients, which is consistent with the fact that 5070% of critical patients require a blood transfusion during their ICU stays [76]

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