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Despite extensive biochemical knowledge of cobalamin metabolism and its physiological importance, the optimal supplementation route for maintaining or restoring adequate vitamin B12 levels remains debated

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The standard dosing schedule starts with 0.25 mg weekly for the first four weeks, increases to 0.5 mg weekly from weeks five through eight, and then may escalate to 1 mg or 2 mg weekly depending on tolerance and response

Koncina E, Roth L, Gonthier B, et al

50 The clinical manifestations of the disease are caused by the complex interactions of the PKLR genetic background, concomitant functional polymorphisms of other enzymes, posttranslational or epigenetic modifications, ineffective erythropoiesis and differences in splenic function