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For patients who have difficulty absorbing B12 through the digestive tractsuch as those with pernicious anemia, gastrointestinal disorders (like Crohns disease or celiac disease), a history of gastric bypass surgery, or those with severe B12 deficiencyour providers often recommend intramuscular B12 injections

Transferrin saturation: This shows how much iron is in your blood compared to how much is available for your body to use

Severe deficiency or malabsorption: Injections may be needed If you have pernicious anemia, a history of gastric bypass, or trouble absorbing B12 due to chronic digestive issues, injections are often the most reliable option

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