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A blood test will confirm a deficiency, with typical thresholds being total B12 levels under 180 nanograms per litre or active B12 below 25 pmol/l

Vial fell or was shaken accidentally If a reconstituted vial was shaken vigorously (dropped, thrown in a bag, held by a toddler), some peptide degradation may have occurred

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This role is related to the synthesis of neurodehyda, and maintains the completeness of sheath nerve fiber function