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Common manifestations include: Haematological symptoms : Fatigue, weakness, pallor, and shortness of breath due to anaemia Neurological symptoms : Paraesthesia (pins and needles) in hands and feet, numbness, difficulty walking, balance problems, and memory disturbance Psychological symptoms : Depression, irritability, confusion, and in severe cases, psychosis Oral symptoms : Glossitis (sore, red tongue), mouth ulcers General symptoms : Loss of appetite, weight loss, diarrhoea Neurological complications can become irreversible if left untreated , particularly subacute combined degeneration of the spinal cord, which affects the dorsal and lateral columns