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The 4 stages of B12 deficiency include (31): Stage 1: decreased levels of vitamin B12 in your blood Stage 2: low levels of vitamin B12 in your cells along with metabolic abnormalities Stage 3: neurological and psychological symptoms like anxiety, confusion, problems with balance, and others Stage 4: macrocytic anemia very large red blood cells (32) B12 deficiency can cause a variety of symptoms, including fatigue, headaches, depression, pale or yellow skin, mental impairment, and pain and inflammation in the mouth and tongue