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He explained that often pernicious anemia is caused by an autoimmune reaction with the patients immune system killing off the intrinsic factor

The most common adverse reactions or laboratory abnormalities leading to interruption of pemetrexed in this arm (2%) were neutropenia (12%), anemia (7%), asthenia (4%), pneumonia (4%), thrombocytopenia (4%), increased blood creatinine (3%), diarrhea (3%), and fatigue (3%)

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Multiple vitamin injections may be administered during the same visit when clinically appropriate