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Hair follicles in the anagen (growth) phase have high energy needs, and studies show that more VEGF around a follicle is linked to more perifollicular vessels, bigger follicles, and thicker hairs
However, frequent blood transfusions can also lead to iron overload, damaging organs such as the liver and heart
routine B12 level monitoring is generally unnecessary once replacement is established, as levels do not reliably correlate with tissue stores Important safety considerations: Older adults may have impaired renal function, though this rarely affects B12 therapy given its wide safety margin
We anticipate that this is going to be an increasingly common clinical entity as the roles of both hydroxocobalamin and methylene blue expand from toxicologic antidotes to adjunct therapies for vasoplegia, poor cardiac output, and sepsis
Keep the final call tied to your own labs, history, medications, and clinician guidance
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