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A problem at any part along the way can impact the bioavailability of vitamin B12

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Epidemiology: High levels of vitamin B12 were found in: Causes: Excessive supplementation (a direct increase in plasma vitamin B12 by excess intake or administration) Increased release of vitamin B12 from tissue stores (liberation from an internal reservoir): Solid tumors (especially hepatic or hematologic malignancies) Liver metastases Increased binding proteins: 7 Excess production: Liver disease (e.g., hepatitis, cirrhosis, hepatocellular carcinoma) – damaged hepatocytes release haptocorrin (transcobalamin I) and B12 into circulation Myeloproliferative disorders – these increase granulocyte production, which leads to more haptocorrin (transcobalamin I/III), a B12-binding protein produced by proliferating myeloid cells