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Where clinical suspicion remains high despite a normal serum B12, additional markers may be requested, including: Holotranscobalamin (active B12) a more specific marker of B12 status, available in some UK laboratories as an alternative or confirmatory test [11] [12] Methylmalonic acid (MMA) elevated in functional B12 deficiency

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Food and Drug Administration for any indication, off-label use among researchers and in experimental settings has grown, driven primarily by animal studies and anecdotal reports