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Other factors that can lead to anemia characterized by large red blood cells (megaloblastic anemia) are: Conditions that negatively affect bone marrow (myelodysplastic syndromes) Breaking down of red blood cells before their normal lifespan is over (hemolytic anemia) Blood clotting disorder that can lead to small blood clots throughout the body (thrombotic thrombocytopenic purpura) There can be other reasons for B12 deficiency: Problem with the body’s ability to absorb B12 from food (food-cobalamin malabsorption) A vegan diet that lacks B12 Certain medications like metformin, proton pump inhibitor therapy, and estrogen contraceptive pills Operations on the stomach or the part of intestine (ileal resection) that absorbs B12 Diseases affecting the part of the intestine that absorbs B12 (ileal disease) Additional causes for an increased number of large red blood cells (macrocytosis): Lack of folic acid (folate deficiency) Use of a medication to treat cancer, psoriasis, and rheumatoid arthritis (methotrexate) Alcohol addiction (alcohol use disorder) Other possible reasons for nerve damage in the hands and feet (peripheral neuropathy): High blood sugar conditions like diabetes mellitus Condition that puts pressure on the nerve in the wrist (carpal tunnel syndrome) Infections or certain medications Deficiencies of other necessary vitamins Excessive alcohol use (alcohol use disorder) What to expect with Pernicious Anemia Before scientists figured out how to treat it, pernicious anemia usually resulted in death