Referral to secondary care is indicated for severe or rapidly progressive neurological symptoms, diagnostic uncertainty, suspected bone marrow failure, or in pregnancy or paediatric cases
Consult a healthcare provider if you experience: Persistent injection site reactions, signs of allergic reaction (rash, difficulty breathing, swelling), or any concerning symptoms that do not resolve quickly
108Xeljanz (tofacitinib): Initial clinical trial results of increased risk of major adverse cardiovascular events and malignancies (excluding NMSC) with use of tofacitinib relative to TNF-alpha inhibitors
They found that it wasnt possible to determine a clear lower limit for which any of these biomarkers can reliably indicate B12 deficiency, but that daily intakes above 4.0 g appear to have no additional benefit
For seniors, the case to skip the conversion step entirely is reasonable
As a water-soluble vitamin, excess B12 is typically excreted in urine rather than stored
