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Before manifesting classic symptoms like pernicious anemia, patients may experience a stage of inadequacy characterized by abnormal levels of biomarkers related to vitamin B12 deficiency, such as holotranscobalamin, methylmalonic acid, and homocysteine

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Existing reviews have further highlighted that pharmacokinetic and safety characterization in humans remains incomplete, complicating clinical counseling regarding timing of discontinuation, perioperative risk stratification, and postoperative resumption (Rahman et al

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