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Vitamin B 12 deficiency can manifest itself in the following clinical pictures: Hyperchromic macrocytic megaloblastic anemia (pernicious anemia, Biermer's anemia, Addison's anemia these are red blood cell maturation disorders) Funicular spinal disease [spinal cord damage] A vitamin B 12 deficiency confirmed by laboratory diagnostics can occur with: Years of malnutrition and malnutrition (e.g strictly vegetarian diet)