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According to the NIH Office of Dietary Supplements, absorption issuesnot intake aloneare a leading cause of low B12 levels

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Broadly speaking, B12 injections give the body further resources to produce more red blood cells to carry larger amounts of oxygen throughout the body, meaning those who receive such treatments can benefit from increased energy and reduced feelings of fatigue

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Cobalamin C defect should be considered in the differential diagnosis in adult patients with atypical hemolytic uremic syndromes, slow unexplained decline in renal function, idiopathic neuropathies, spinal cord degenerations, ataxias, unexplained or recurrent thrombosis, visual field defects, maculopathy, and optic disc atrophy (120)