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When deficiency is suspected based on clinical features (fatigue, paraesthesia, cognitive changes) or risk factors (vegan diet, gastric surgery, certain medications), serum B12 measurement guides appropriate intervention

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She’d been on hydroxocobalamin for some years now because of chronic fatigue but since the brand she was taking became unavailable and she had to switch to Neo B12 they were giving her migraines and somehow their effectiveness was also not as desired