nature.com/articles/s41433-...
This is an interesting article. Obviously NICE has changed since. But I appreciate the observation...
"Current NICE guidance appears to be obsolete and should be used with caution. Vitamin B12 deficiency manifests as a wide range of neurological deficits and symptoms before any effect is seen on haematological markers. Patients with neurological symptoms or signs such as new pupil abnormalities, eye pain, cranial nerve palsies, nystagmus, visual field defects, tinnitus, paraesthesia or neuralgia should be screened for B12 deficiency."