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The role of homocysteine in increasing the risk of hemolysis in vitamin B12 and folate deficiency has been demonstrated in vitro .[7] We postulate that the high homocysteine levels in our case may have played a role in ensuing hemolysis in addition to intramedullary destruction of RBCs

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Vegans and Vegetarians: B12 is found almost exclusively in animal products, so those on plant-based diets must use fortified foods or supplements Older Adults: reduced stomach acid can decrease B12 absorption from food as we age People with Pernicious Anemia: this autoimmune condition prevents the body from making intrinsic factor, a protein needed for B12 absorption Individuals with Gastrointestinal Conditions: diseases like Crohn's or Celiac disease can impair nutrient absorption Patients Who Have Had Gastric Surgery: procedures like gastric bypass can reduce the body's ability to absorb B12 Certain Medications: drugs such as Metformin and proton pump inhibitors (PPIs) can interfere with B12 absorption Medically-Approved vs

This enzyme converts homocysteine and 5-methyl tetrahydrofolate (THF) into methionine and THF