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In one study of 141 consecutive patients with neuropsychiatric symptoms from B12 deficiency, 28% had a normal hematocrit, a normal mean corpuscular volume, or both

doi:10.1200/JCO-24-01349 Ahn MJ, Tanaka K, Paz-Ares L, et al

Those patients get arthritis faster than others. Inherited abnormalities in the shape of the bones surrounding the knee joint can also be a cause

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