Two causes lead to deficiency of vitamin B12: inadequate intake or poor absorption. Inadequate intake may result from dietary deficiencies. Failure to absorb occurs from a deficiency in intrinsic factor. Pernicious anemia is significantly more common in patients with autoimmune-related disorders, such as thyroiditis, myxedema, and Graves' disease, which, in theory at least, decrease the hydrochloric acid production that is essential for intrinsic factor formation. Gastric resection can also result in the absence of intrinsic factor.

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