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In some instances, a deficiency in B12 may present symptoms similar to hemolytic anemia, including intramedullary hemolysis and elevated levels of lactate dehydrogenase (LDH), which raises concerns about serious conditions like thrombotic microangiopathy (TMA) [3,4]

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PMID 29477223

[13] Chloramphenicol has been shown to blunt reticulocyte response to cyanocobalamin, while ethanol, colchicine, and nitrous oxide interfere with cobalamin metabolism or utilization, each warranting clinician awareness when evaluating suboptimal treatment outcomes

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