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similarly not universally available and has multiple causes Full blood count to identify macrocytosis or megaloblastic changes Blood film to assess red blood cell morphology NICE CKS guidance and the British Society for Haematology (BSH) recommend that clinical symptoms should always be considered alongside laboratory values, particularly in high-risk groups such as post-bariatric surgery patients

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Injection site reactions including redness, itching, or mild swelling occur in approximately 3-5% of patients and typically resolve within 24 hours

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