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Clinical features Signs of anemia (e.g., fatigue, pallor) [8] Mild scleral icterus and/or jaundice Neurological disturbances are generally symmetrical Peripheral neuropathy: tingling, numbness, pins-and-needles sensation, coldness (especially in the lower extremities) Subacute combined degeneration of spinal cord (SCD): symmetrical demyelination of the spinal cord tracts occurs in vitamin B 12 deficiency due to insufficient vitamin B 12 -dependent fatty acid synthesis and production/maintenance of myelin It manifests with the following symptoms: Paresthesia, impaired proprioception, loss of vibratory sensation, tactile sensation, and position discrimination due to demyelination of the dorsal columns Spastic paresis due to demyelination of the lateral corticospinal tracts (axons of upper motor neurons) Gait abnormalities (spinal ataxia) resulting from the damage of spinocerebellar tracts and dorsal columns Long-term deficiency can lead to irreversible neurological damage

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