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Doctors consistently deny them from pernicious anemia patients and people with other absorption issues

Numerous studies have examined homocysteine levels to determine whether vitamin B12 deficiency occurs at the tissue level [2,3,19-21]

The clinical significance of metformin-induced vitamin B12 deficiency ranges from milder manifestations, such as fatigue and paraesthesia, to severe features like pancytopenia and degeneration of the spinal cord

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Earlier initiation may be appropriate when significant comorbidities persist, but timing should be individualized based on surgical procedure type and metabolic status

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