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In these cases, your doctor may request additional tests to assess functional B12 status: Methylmalonic acid (MMA) : Elevated levels suggest tissue B12 deficiency, as B12 is required to metabolise MMA (note that renal impairment can also raise MMA levels) Homocysteine : Raised homocysteine can indicate B12 or folate deficiency (also affected by renal function) Holotranscobalamin (active B12) : Measures the biologically active fraction of B12 [4] [8] Full blood count : May reveal macrocytic anaemia (enlarged red blood cells) characteristic of B12 deficiency If B12 deficiency is confirmed, your doctor will likely investigate the cause with tests such as intrinsic factor antibodies (and sometimes parietal cell antibodies) to check for pernicious anaemia, or coeliac serology if malabsorption is suspected