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Vitamin B 12 (Cobalamin) Deficiency Causes Causes include dietary deficiency (usually seen only in vegans), pancreatic insufficiency, decreased production of intrinsic factor (eg, pernicious anemia or gastrectomy), decreased ileal absorption of vitamin B12 (eg, Crohn disease, Diphyllobothrium latum infection, sprue, or surgicalresection of small intestine), or blind loop syndrome (leading to bacterial overgrowth and resulting competition for vitamin B12)