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Source of Vitamin B12, Image Credit: marina_ua / Shutterstock Causes Vitamin B12 deficiency may arise due to: Nutritional deficiency especially in elderly individuals on restricted diets, and alcoholics Malabsorption syndromes such as pernicious anemia Gastrointestinal disorders leading to malabsorption such as atrophic gastritis or H2-receptor blocker use for prolonged periods Others such as Whipples disease or Crohns disease, intestinal surgery or strictures with resulting bacterial overgrowth that competitively take up vitamin B12 in the ileum Clinical features Hematologic Classically, vitamin B12 deficiency has been associated with megaloblastic macrocytic anemia