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Genetic variants such as MTHFR, MTR and MTRR can influence how efficiently cyanocobalamin is metabolized and utilized

Injections are given subcutaneously (just under the skin), and injection sites should be rotated daily to prevent lipoatrophy or irritation

Germline-encoded naturally occurring autoantibodies (NOAbs) then bivalently bind to these structures on the cell membrane, thereby becoming necessary to selectively clear aged RBCs [219]

After that, it will likely be necessary to receive another round of viscosupplementation injections