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2025 Jan 9;188(1):157-174.e22

Symptoms of vitamin B12 deficiency may include any or all of the following: Chronic fatigue (4) or low energy (despite getting enough sleep) Shortness of Breath Macrocytic anemia (5) High MCV (mean corpuscular volume on CBC analysis) Neurological changes that can mimic dementia (6) Depression (7), anxiety, and other mood disorders Difficulty with concentration (8) Brain fog Skin changes like hyperpigmentation (9), vitiligo, or angular stomatitis Hair changes (including hair loss (10)) Perhaps you can relate to one or more of these symptoms noted above

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The schedule would look like this: Get rituximab infusion Wait 4 weeks before next dose (about 5 months later) and get COVID-19 vaccine 3-4 weeks later: Get second COVID-19 vaccine (depending on Moderna or Pfizer) 2-4 weeks later: Get next rituximab infusion This kind of schedule is recommended for patients whose disease activity will allow them to be off medication for an extended period, so it may not be advised for all patients