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Symptoms of vitamin B12 deficiency often first manifest as hematological issues, such as pernicious anemia and megaloblastic anemia, which involve enlarged red blood cells due to impaired DNA synthesis during erythropoiesis

Vukojevic et al., 2020), bypassing the occlusion (Vukojevic et al., 2018

Time assessment: If over 30 days since reconstitution, potency is likely compromised regardless of appearance