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Vitamin B12 deficiency is diagnosed on the basis of blood tests

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Extended follow-up studies would identify any delayed adverse effects and establish whether therapeutic benefits persist, diminish, or require continued treatment for maintenance

Using metabolic markers of B12 status like methylmalonic acid and homocysteine to aid in the diagnosis of clinically manifested vitamin B12 deficiency has advantages, but also shortcomings [10,11], such as the high costs of measurements, the limited availability, and the impact of renal insufficiency on the concentrations