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Future studies are warranted to elucidate these complex interrelationships and inform targeted therapeutic strategies

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Conclusion Whilst severe B12 deficiency has a clear clinical picture with characteristic haematological and/or neurological features, establishing mild or borderline deficiency can be problematic as serum levels are maintained at the expense of tissue concentrations, and therefore serum levels of B12 may be in the low normal or borderline range despite a deficiency