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Nat Rev Gastroenterol Hepatol (2021) 18:64967

This can be due to COMT, MTR or MTRR genetic mutations which help the body convert B12 into its active forms for use at the enzymatic and cellular level

In consequence, with the thrombocytopenia and haemorrhage, the expected lack of NO-suppression of platelet aggregation [33], the acceleration and amplification of the induced pattern of platelet activation resulting in platelet exhaustion [9] (L-NAME), grossly correspond to the suggested inhibition of platelet aggregation, by direct action on an intraplatelet constitutive calcium-dependent NOS [3335] (L-arginine)

International Perspective The European Medicines Agency has not approved either compound for human therapeutic use