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In the fourth and last stage of B12 deficiency, clinical manifestations are experienced by the individual including macrocytic anemia (a form of anemia in which red blood cells are larger than usual, hence the term macro) and, if left untreated, irreversible neurological damage

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A technically normal value may, depending on individual variability, be insufficient in a specific patient, as shown by the accumulation of MMA and homocysteine in the blood