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22,23 In patients with a normal or low-normal serum vitamin B 12 level, complete blood count results demonstrating macrocytosis, or suspected clinical manifestations, a serum methylmalonic acid level is an appropriate next step 1,2,6,18 and is a more direct measure of vitamin B 12 's physiologic activity
Increase calorie burn at rest (BMR elevation)
Refrigerate immediately at 28C and use within 28 days
Testing and Diagnosis: A proper B12 deficiency diagnosis should always be confirmed by blood tests, as symptoms alone can be misleading
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