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These include: Complete Blood Count (CBC) to check for better anemia Serum Vitamin B12 levels to make sure the dose is right Methylmalonic acid (MMA) and homocysteine levels to see how the body is reacting Reticulocyte count to see how the bone marrow is doing Clinical Improvement Markers We also watch for signs of improvement in how patients feel

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Injection Depth and Technique If the injection is too shallow or delivered too quickly, the medication may not disperse evenly

Sludging and sickling in peripheral vessels may lead to complete or partial obliteration of a vessel with diminished perfusion to surrounding tissues