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Laboratory tests showed severe pancytopenia, with the following results: hemoglobin (Hb): 3.3 grams per deciliter (g/dl), white blood cell (WBC) count: 1.72 10 9 /L, platelet count: 28 10 9 /L, mean corpuscular volume (MCV): 100 femtoliters (fL), and absolute neutrophil count (ANC): 1.07 per microliter of blood (muL)

Although researchers are still investigating the exact mechanism, most evidence suggests that metformin interferes with the absorption of vitamin B12 in the last part of the small intestine, known as the ileum

Studies show that approximately 1% of a high-dose B12 supplement is absorbed through passive diffusion along the entire gastrointestinal tract, completely bypassing the need for Intrinsic Factor or perfect stomach acid levels