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Before manifesting classic symptoms like pernicious anemia, patients may experience a stage of inadequacy characterized by abnormal levels of biomarkers related to vitamin B12 deficiency, such as holotranscobalamin, methylmalonic acid, and homocysteine

These contrasting findings highlight the imperative need to establish standardized exposure models and integrate multi-omics analyses (Table 5)

Records of the medical evaluation and any recommendations should be incorporated into research records

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