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Vitamin B12 deficiency can be caused by blood count changes such as hyperchromic macrocytic megaloblastic anemia or nerve damage, e.g
How are vitamin B12 injections used at OmniSpine Pain Management to support energy levels and overall wellness in patients with fatigue or nerve-related symptoms
But my job is to recommend treatments that have been tested in real people, with measurable outcomes, reproducibility, and safety data
doi:10.1146/annurev.biochem.72.121801.161828
But you can prevent it by following storage guidelines and tracking how long your medication has been outside the recommended temperature range
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