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Signs of B12 deficiency develop gradually and can be non-specific initially: Haematological manifestations: Macrocytic anaemia (enlarged red blood cells) Fatigue, weakness, and lethargy Pallor and shortness of breath Glossitis (inflamed, smooth tongue) Neurological and psychiatric symptoms: Paraesthesia (pins and needles) in hands and feet Peripheral neuropathy with numbness or burning sensations Ataxia and difficulty walking Memory problems and cognitive impairment Depression, irritability, or mood changes In severe cases, subacute combined degeneration of the spinal cord It is crucial to note that neurological damage can occur even in the absence of anaemia, and if left untreated, some neurological effects may become irreversible