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Therefore, clinicians need to recognize the neurologic symptoms and signs of vitamin B12 deficiency and specifically seek evidence for this diagnosis if it might explain a patients condition rather than waiting for hematologic evidence of vitamin B12 deficiency to turn up on a complete blood count ordered for that or other purposes

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Chowdhury P et al

To optimize absorption and minimize local irritation, it is recommended to rotate injection sites, such as the upper arms, thighs, and areas around the navel

If there has been long-standing damage, this triggering might overwhelm the system, temporarily worsening symptoms