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If you receive compounded tirzepatide that was prepared without B12 and the liquid has any color at all, that warrants a call to your pharmacy

High MCV is typical of a number of conditions, including: Newborns and infants Megaloblastic anemias (folate deficiency anemia and vitamin B12 deficiency anemia) [12, 13] Reticulocytosis increased red blood cell production (congenital hemolytic anemia and acute blood loss) [14] Alcoholism [15] Liver disease [16] Hypothyroidism [17] Aplastic anemia [16] Myelodysplastic syndrome [16] Acute leukemia [16] Drugs (methotrexate, antiretroviral, anticonvulsive, and sulfasalazine) [16] These are not necessarily exhaustive lists of potential causes of high and low MCV, and they shouldnt be used to self-diagnose anything