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Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (which can be caused by ingestion of corrosives, extensive tumors, and conditions associated with gastric atrophy, such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy) Structural lesions leading to vitamin B 12 deficiency, including regional ileitis, ileal reactions, and malignancies Competition for vitamin B 12 by intestinal parasites or bacteria

Other good natural sources include meat, fish, eggs and dairy products

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If reticulocytes have not increased after treatment or if reticulocyte counts do not continue at least twice normal as long as the hematocrit is less than 35%, diagnosis or treatment should be reevaluated