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chronic liver disease and hepatitis may present with elevated levels Renal impairment : Reduced clearance can contribute to accumulation, though this is rarely clinically significant Solid tumours : Certain malignancies, particularly hepatocellular carcinoma and metastatic disease, may elevate B12 levels [3] Evidence suggests that unexplained markedly elevated B12 levels without supplementation may sometimes be associated with underlying disease

Michael Hi, as I await arrival of the 3 months of B-12 kit from PA Relief, I wanted to ask I have what seems to be optical neuropathy that has responded some to B-12 sublingual last 3 weeks, but not enough, given its 7 months duration, and I have neurological symptoms of pernicious anemia, very low intrinsic factor, and 167 last B-12 lab April 22