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[55] If nervous system damage is present and blood testing is inconclusive, a lumbar puncture may be carried out to measure cerebrospinal fluid B 12 levels

Other patient groups who may benefit include: Individuals with malabsorption disorders (such as coeliac disease or inflammatory bowel disease) who are also on anticoagulation therapy Elderly patients on warfarin with poor dietary intake or limited food variety Those recovering from illness or surgery whilst maintained on warfarin Patients with multiple dietary restrictions that limit natural vitamin intake It is essential to emphasise that not all patients on anticoagulation require vitamin K-free supplements

Santra M, Zhang ZG, Yang J, Santra S, Santra S, Chopp M, Morris DC

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