All Rights Reserved. Epub 2014 Oct 16. 11, 715 (2013). Vitamin deficiency anemia usually develops slowly over several months to years. Urbanski, G. et al. 11, 110 (2011). IUBMB Life 68, 303310 (2016). In our study, an increased risk of cancer was associated with patients having a persistent elevated B12 (group EE) but not with those showing transient elevated B12 (group EN). 25, 825837 (2019). Thrombocytopenia can lead to nosebleeds, gum bleeds, and bruises. Why vitamin B12 deficiency should be managed aggressively. Uveitis (inflammation of the iris in the eye). Relationship between serum B12 concentrations and mortality: experience in NHANES. 2023 Cryptoguiding. Epub 2011 Oct 22. Vitamin B12 is an essential micronutrient that plays a fundamental role in cell division and one-carbon metabolism. Vitamin D supplements may treat joint pain in some people who have a vitamin D deficiency. Minimally Invasive Surg. Clin. These were younger, male, with kidney disease, lower serum calcium and higher 30-day mortality (all p<0.01). 24. They sometimes just are not aware of it. These disease states result in an increased production of white blood cells including Granulocytes. CAS It's also rich in protein, which is good for cellular repair. TC is a 43 kDa non-glycosylated serum protein that is synthesized primarily in the enterocytes and carries vitamin B12 to the tissues via a specific receptor with a high affinity for holo-TC. B12 is stored in the body. An official website of the United States government. However, ICs were detected in 10 frozen samples and in seven cases (25%) of the prospective study, respectively. Prevalence of high B12 was 1.3%. One Cause of Vitamin B12 Deficiency. Chem. ADS Causes Of High B12 Without Supplementation, In this article we will discuss the causes of high B-12without supplementation. Of these patients, 10/26 (38%) had elevated ferritin levels secondary to liver disease, 7/26 (27%) malignancy/infection, 6/26 (23%) malignancy alone, 1/26 (4%) autoimmune disease, and 1/26 (4% . The association between elevated B12 and solid cancers was demonstrated by two population-based studies: a B12>800pmol/L (1084ng/L) was associated with a diagnosis of cancer in the following year with a Standardized Incidence Ratio of 6.3 [95% CI 5.76.9] in a Danish cohort16, and a B12 between 800 and 1000pmol/L (10841355ng/L) was associated with an Incidence Rate Ratio of 2.9 [95% CI 2.43.5] in a British cohort17. Initially thought I had a yeast infection redness, swelling, itching. & Andrs, E. Hypervitaminmie B12: physiopathologie et intrt en pratique clinique. Intrinsic factor is a protein made in the stomach. BMJ Case Rep. 2022 Jan 13;15(1):e247660. 16, 235 (2015). To date, the mechanism of the elevated vitamin B12 concentrations in ALPS patients has not been determined and we sought to explore the source of elevated vitamin B12. In addition to aiding in red blood cell formation and mood disorders, vitamin B12 is an important mineral for those with autoimmunity.For example, individuals with autoimmune conditions such as human immunodeficiency virus (HIV), Hashimoto's thyroiditis, and . government site. The cancer-free survival significantly differed between the 3 groups (p<0.001, Fig. So solid tumors are a cause of high B12 due to increased release of stored B12 and decreased uptake. Read on to learn more about testing B-12 levels and what the test results mean. The swollen lymph nodes in the neck, armpit, and groin are usually the most noticeable symptoms of the disease. . What stocks should I buy in a bear market? doi: 10.1002/pul2.12173. These particular transport proteins are made more commonly in certain cell lines like the granulocytes, a type of white blood cell. Essentially if you remain having persistently elevated B-12 levels in the absence of supplementation you should explore this further with more testing. Nat. Screen. Unable to load your collection due to an error, Unable to load your delegates due to an error. Keep reading on to find . Diagnosis. BMC Nephrol. Federal government websites often end in .gov or .mil. Basophils are a type of white blood cell that have some role in immune surveillance (such as detecting and destroying very early cancers) and wound repair. Osteoarthritis is a condition wherein the cartilage cushioning the bones, is damaged and so the bones get rubbed against each other and nerves experience more pressure due to the same. Most people with vitamin B12 or folate deficiency anaemia have underdeveloped red blood cells . Dizziness. Clipboard, Search History, and several other advanced features are temporarily unavailable. Elevated plasma vitamin B12 concentrations are independent predictors of in-hospital mortality in adult patients at nutritional risk. As you will see below look at some of the problems that can come up with the transcobalamin transport proteins and various diseases that can cause elevated B-12 when you're not supplementing with B-12. Precipitation with PEG is an easy method to confirm the presence of ICs and to evaluate serum vitamin B12 levels in these patients. High B12 levels are found in many myloproliferative disease. Basophilic Disorders - Merck Manuals Consumer Version Disclaimer. Vlasveld, L. T., Bos, G. M. J., Ermens, A. In this study, characteristic of patients with serum vitamin B12 levels higher than 2500 pmol/L (high B12) were studied. C.L., A.G., O.C., A.P. Not getting enough vitamin B12 to the point of a deficiency can cause a variety of serious symptoms including depression, joint pain, and fatigue. Indeed, vitamin B12 is the cofactor of methionine synthase, which is implicated in methylation reaction and in the synthesis of purine bases29,30, and these functions are crucial in tumor-initiating cells and cell proliferation30,31. 8. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. and G.U. Clin. The https:// ensures that you are connecting to the An elevated B12 level was defined as1000ng/L1,4,24,25,26. Prevalence and evaluation of B12 deficiency in patients with autoimmune Scand. [Hypervitaminemia B12 (high level of cobalamin): physiopathology, role and interest in clinical practice]. Having an excessively high or extremely low amount of vitamin B12 in your system can indicate a potential health problem; one of the diseases linked to B12 levels is a form of leukemia called chronic myelocytic leukemia. Moreover, thyroid disease is often caused by autoimmune disease (Hashimoto's thyroiditis). Bethesda, MD 20894, Web Policies You may still have the condition even if your vitamin B12 levels are normal. The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. & Nexo, E. Cobalamin related parameters and disease patterns in patients with increased serum cobalamin levels. NCI CPTC Antibody Characterization Program. Presse Med. Ter Arkh. Moreover, a prospective study was carried out during three consecutive months. Elevated plasma vitamin B12 has been associated with solid cancers, based on a single B12 measurement. Clin. A codified approach is needed to determine the potential indications of a search for high serum cobalamin and the practical clinical strategy to adopt upon discovery of elevated cobalamin levels. Vitamin B 12 and its binding proteins in hepatocellular carcinoma and chronic liver diseases. Is high vitamin B12 status a cause of lung cancer?. Vitamin B12 also plays an important role in hematopoiesis and maintaining the integrity of the nervous system. Geriatrics. and transmitted securely. Internet Explorer). 105, 17991805 (2013). The information in the article is based a research paper that can be found here ( Causes of High B12 Without Supplementation in Clinical Practice ). See, in many autoimmune conditions, there is the risk of malabsorption which can result in nutrient deficiencies as well, it is best to get the blood test done in a fasted state and have abstained from vitamin B12 supplementation for three days, a serum vitamin B12 test does not differentiate between active and inactive forms, vegetarians and vegans may be at increased risk of developing a vitamin B12 deficiency, autoimmune patients often have a defect in how their bodies break down and utilize certain nutrients, Tips for Navigating the Holidays with Hashimotos, 25 Healthy Recipes for Thanksgiving Dinner, Thanksgiving Blessings: How I Learned to be Grateful for My Autoimmune Disease, Five Cold Weather Tips for Arthritis Sufferers, How to Make Household Cleaner Non Toxic and Safe. Patients with pernicious anemia or those supplemented with vitamin B12 were also excluded. Keywords: Be sure to check out the next article in a few weeks, what to do about elevated B-12 levels. However, this would identically impact the 3 groups. Consequences include atrophic gastritis, B12 malabsorption, and, frequently, pernicious anemia. Med. High serum concentration of cobalamin is a common but underestimated finding. sharing sensitive information, make sure youre on a federal As the study aimed at comparing persistent and non-persistent elevated B12, patients who had only the last measurement1000ng/L were excluded. Vitamin B 12 is an essential micronutrient that plays a fundamental role in cell division and one-carbon metabolism. Serum vitamin B12 decreased to normal values after precipitation with PEG, and size exclusion chromatography confirmed ICs. Actually I now am like most people with autoimmune diseases because the test showed me deficient. Both of which would be elevated in the presence of B-12 deficiency. Gimsing, P. Cobalamin forms and analogues in plasma and myeloid cells during chronic myelogenous leukaemia related to clinical condition. Copyright 2023 by American Society of Hematology, https://doi.org/10.1182/blood.V112.11.4898.4898, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, 5-methyltetrahydrofolate-homocysteine s-methyltransferase. HC is a glycosylated serum protein of ~68kDa that is produced mainly by myeloid cells and binds the majority of circulating vitamin B12 (7090%). Kingma TJ, Bascoy S, Altaf MD, Surampudy A, Chaudhry B. Cureus. J. False increased vitamin B12 levels in autoimmune gastritis and subacute Bookshelf 8600 Rockville Pike La Presse Md. Vitamin B12 in serum is bound to two proteins, haptocorrin (HC) and transcobalamin (TC). A low level of vitamin B12 in the blood indicates pernicious anemia. Among these patients, plasma B121000ng/L at T1 were found in 344 patients without any known elevated-B12-related causes. Article The Status of Oxidative Stress in Patients with Alcohol Dependence: A Meta-Analysis. Google Scholar. Berg, R. L. & Shaw, G. R. Laboratory evaluation for vitamin B12 deficiency: The case for cascade testing. Autoimmune disease, especially against blood cells; . Among the causes of elevated B12, incident myeloid blood malignancies and chronic liver diseases were more frequent in the EE group (p<0.001 and p<0.001, respectively). 36, 585590 (2003). The incidence of elevated-B12-related causes could be underestimated due to the retrospective and non-interventional nature of the study. In a previous video we talked about What Does A High B-12 Level Mean and some things to think about with that. Functional cobalamin deficiency can thus occur at any serum level. Abstract. Neutropenia occurs when the body destroys infection-fighting cells called neutrophils. Assays were initially performed to search for B12 deficiencies. F.C. Conditions that can increase B12 level include: Liver disease (such as cirrhosis or hepatitis) Myeloproliferative disorders (for example, polycythemia vera and chronic myelogenous leukemia). Before we get into this, we have to take first things first. & Nexo, E. Unexpected high plasma cobalamin/Proposal for a diagnostic strategy. Conclusions: 2). Chem. Arendt, J. F. B., Pedersen, L., Nexo, E. & Srensen, H. T. Elevated plasma vitamin B12 levels as a marker for cancer: A population-based cohort study. 196 likes, 10 comments - CultivateElevate (@cultivateelevate) on Instagram: "We talk about Soy and why it should be avoided. Level was 33 (27-32). Sign up for the Nature Briefing: Cancer newsletter what matters in cancer research, free to your inbox weekly. What vitamin Am I lacking if my joints hurt? Patients with elevated plasma B12 (1000ng/L) at first measurement (n=344) were matched for age and sex with patients having 2 normal B12 measurements (<1000ng/L) (NN group, n=344). FOIA doi: 10.7759/cureus.31936. Complications. A list of national and international resources and hotlines to help connect you to needed health and medical services. Nutrients. 3. The death rate was higher in the EE group than in the other groups (p<0.001). Biochem. As noted above, sometimes people are actually deficient in B-12. The site is secure. Thus, doctors should monitor patients with ALPS for symptoms of lymphoma, such as night sweats, fever, fatigue, weight loss, loss of appetite, and sudden lymph node enlargement. The most common rise in immunoglobulin levels is polyclonal, and due to immune system activity caused by infection or autoimmune diseases. Sci. Article Accessibility 6 Degrees of Vitamin B12- B12 Deficiency and Autoimmune Disease Reviews: 88% of readers found this page helpful, Address: Suite 835 34136 Adrian Mountains, Floydton, UT 81036, Hobby: Skimboarding, Photography, Roller skating, Knife making, Paintball, Embroidery, Gunsmithing. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. 22. A certain type of vitamin B12 may be given through the nose. Increased vitamin B12 levels are associated with mortality in critically ill medical patients. So taking all those causes of elevated B-12 level into consideration, the first thing you want to do is find out if you're actually deficient in B-12. . CAS Serum Vitamin B12 was increased in 1186 (81.2%) patients, mainly middle-aged males, with sepsis, multiorgan failure, and higher 30-day mortality (all p < 0.01). Why is a vitamin B-12 level test useful? It is noteworthy that most of diagnosed neoplastic diseases were previously unknown and at a non-metastatic stage. T2 was the test immediately following T1 with at least 1month between T1 and T2. 17, 235238 (1998). By using this Site you agree to the following, By using this Site you agree to the following, Need relief - not sure what is going on - std or autoimmune, Had IV Infusion for possible MS, test results unclear, The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life. These may include: Fatigue. Total and holo-HC levels were 36- and 32-fold higher than the upper limit of the reference interval (Total HC: 250840 pmol/L; Holo-HC: 240680 pmol/L), respectively, in ALPS patients. The information in the article is based a research paper that can be found here (, The causes of high B-12 levels without supplementation are numerous. In this article we will explore this topic in a little bit more detail. Thank you for visiting nature.com. This is how inflammation starts and is perpetuated. Clin. , All content found on the AutoimmuneSisters.com Website, including: text, images, audio, or other formats were created for informational purposes only. Clin Chem. This does not necessarily mean you have these things but problems that could be going on to cause elevated B-12. However, a falsely normal or high value of vitamin B12 in the blood may occur if antibodies interfere with the test. & Baker, E. R. Cobalamin (vitamin B12) and holotranscobalamin changes in plasma and liver tissue in alcoholics with liver disease. There are some labs you can do to figure this out. 17, 1 (2017). Causes. Reduce the amount of animal-derived foods that appear in your diet, as they contain vitamin B12. As the cell membranes are damaged there are a cascade of inflammatory molecules produced. However, the study methodology did not allow for determination of the most suitable time to perform this control. Clipboard, Search History, and several other advanced features are temporarily unavailable. Pearls and pitfalls in nonalcoholic fatty liver disease: tricky results are common. We applied the strengthening the reporting of observational studies in epidemiology (STROBE) statement to observational studies. Autoimmune Lymphoproliferative Syndrome (ALPS) Symptoms & Diagnosis Cryptoguiding is a website that writes about many topics of interest to you, it's a blog that shares knowledge and insights useful to everyone in many fields. All Rights Reserved. High B-12 levels could be an epiphenomenon or related to a deeper issue with B-12 transportation. What level of B12 is dangerously high? ALPS is a rare autoimmune disease in children resulting from defective lymphocyte apoptosis and is characterized by lymphoproliferation, peripheral accumulation of DNT cells (double-negative T cells; TCR alpha/beta +, CD3+ CD4 CD8), often leading to autoimmune multilineage cytopenias. People who have low levels of vitamin D often have joint pain. When I was initially hospitalised in 2014, I showed a reading of 1353 (with 200-900 being the normal . What happens when vitamin B12 is very high? The association between elevated B12 and solid cancers was demonstrated by two population-based studies: a B12 > 800 pmol/L (1084 ng/L) was associated with a diagnosis of cancer in the following year with a Standardized Incidence Ratio of 6.3 [95% CI 5.76.9] in a Danish cohort16, and a B12 between 800 and 1000 pmol/L Elevated levels of serum cobalamin may be a sign of a serious, even life-threatening, disease. (Video) What Does It Really Mean If You Have High B12 Levels? Cancer Inst. Compared with the NN group as a reference, only the EE group was significantly associated with incident cancer with HR 5.90 [95% CI 2.7912.45] (p<0.001), contrary to the EN group (HR 1.52 [95% CI 0.703.30], p=0.29) (Table 2). Zibold J, von Livonius B, Kolarova H, Rudolph G, Priglinger CS, Klopstock T, Catarino CB. Essentially these transcobalamin molecules are carried through the cell membrane after binding to the B-12 receptor on the cell. An official website of the United States government. Epub 2007 Nov 9. SDS-PAGE and western blot analysis revealed the presence of HC in lymphocyte lysates of ALPS but not apparently healthy controls. Patients in whom active screening should be discussed need to be better targeted to allow early diagnosis and limit unnecessary investigations. We anticipated this bias using a survival competing risk model with the death as the competing risk. What Is Pernicious Anemia? - Verywell Health J. Persistent elevation of plasma vitamin B12 is strongly associated with solid cancer, https://doi.org/10.1038/s41598-021-92945-y. It is the TCN 2 transporter that is the main transporter for B-12. 9 Best Vitamin B12 Supplements in 2023, According to Health Experts eCollection 2022 Oct. Yang M, Zhou X, Tan X, Huang X, Yuan L, Zhang Z, Yang Y, Xu M, Wan Y, Li Z. Antioxidants (Basel). People with severely low levels of B12 may need more shots in the beginning. Further studies are needed to elucidate the mechanism for the increased synthesis and secretion of HC from lymphocytes of ALPS patients, but altered cytokine profiles, including increased interleukin-10 levels in ALPS may contribute. Vitamin B-12 - Mayo Clinic 2014 Southwest Integrative Medicine. On the contrary, elevated B12 levels encountered in some cancers could be correlated with the tumor mass or the granulocytic immune response5,6,20. The major clinical symptoms of ALPS result from lymphoproliferation, or the excessive production of a type of white blood cell called a lymphocyte, and autoimmune destruction of blood cells. The risk continues past age 40, although the data on older age groups are limited. Scientific Reports (Sci Rep) The alpha risk was 5%. These results could help to select patients in whom the screening for solid cancers would be of interest. Google Scholar. Even though the title is "cause of high B-12, Role of Transcobalamin in High B-12 Without Supplementation, Role of Solid Tumors and Hepatitis in High B12 Without Supplementation, Role of Blood Cancers in High B12 Without Supplementation, Blood cancers in general can lead to an increase in B-12 levels due to an increased production of these TCN 1 and TCN 3 transcobalamin proteins. Now this doesn't necessarily explain the elevated B-12 levels but it does explain how one can be deficient in B-12 in the presence of higher serum B-12 levels. Patient organizations can help patients and families connect. Some authors suggested that the development of solid cancers could be secondary to the elevated B1227,28. The 344 patients in the NN group were randomly selected from the 7,889 patients with plasma B12<1000ng/L at T1 and T2. Clinically, it can be paradoxically accompanied by signs of deficiency, reflecting a functional deficiency linked to qualitative abnormalities, which are related to defects in tissue uptake and action of vitamin B12. The goal of treatment is to increase your vitamin B12 level: Treatment involves a shot of vitamin B12 once a month. Arendt, J. F. B. High serum cobalamin in dysimmune and inflammatory diseases may be linked to an increase in TCB II during the acute phase of inflammation. High prevalence of vitamin B-12 insufficiency in patients with - PubMed J. 4, 5 All conditions may show elevated concentrations of B12 transport proteins. Introduction: To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Irregular heartbeats. Bull. Patients with B121000ng/L at T1 were selected and matched with a control group. Glomerulonephritis (inflammation of the kidneys). So if you are finding high B-12 levels and elevated methylmalonic acid, you would want to supplement with B-12 until that methylmalonic acid goes down. [Hypervitaminosis B12 - a new marker and predictor of prognostically unfavorable diseases]. Background and objectives: In Crohn's disease (CD), belonging to inflammatory bowel disease, the small intestine is involved in most cases. Brousselle, A. et al. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. The difference was linked to a more frequent occurrence of incident solid cancer in the EE group (p<0.001 compared with EN and NN groups), as the EN and NN groups did not differ (p=0.28). We offer this Site AS IS and without any warranties. Only vitamin B12 bound to TC is available for cellular uptake and use as coenzymes for L-methylmalonyl-CoA mutase and methionine synthase that synthesize succinyl-CoA and methionine, respectively. With liver cancer some of the liver cells are damaged as a result the liver cell are are not expressing as many B-12 receptors. The age of the patients was similar in the 3 groups (Table 1). It also is normal for lymph nodes to change somewhat in size, shape, or feel over time. Lymphoproliferative disorders are a set of disorders characterized by the abnormal proliferation of lymphocytes into a monoclonal lymphocytosis. Paradoxically, hypercobalaminaemia can be associated with a functional B12 deficiency. Signs and symptoms may be subtle at first but usually increase as the deficiency worsens. FOIA Google Scholar. If someone has been on any form of a supplement containing B12, it can leave the serum levels of B12 elevated for a long time afterwards. As a result, there is more binding of the B-12 but less of it is getting taken up into the cells because it's all bound by non-functional transport proteins. At least one cause of elevated B12 was diagnosed in the follow-up of 75/144 (52.1%) patients in the EE group, 34/200 (17.0%) in the EN group, and 38/448 (11.0%) in the NN group (p<0.001, Table 1). Non-cancerous swelling of the lymph nodes (lymphadenopathy) that lasts for more than six months, Autoimmune disease, especially against blood cells, Family history of ALPS or ALPS-like features. Biomark. I have also been on metformin 12 years and know that can lead to b12 deficiency. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. The prognostic nature of elevated B12 in solid cancers suggested the question of a possible link with the tumor mass or the capacity for proliferation20. The elevated-B12-related causes were: acute liver disease (acute elevation of transaminases to more than 2 times normal) or chronic liver disease (dysmorphic ultrasound appearance, persistent biological signs of hepatocellular insufficiency, and/or histology suggestive of cirrhosis), severe chronic renal failure (MDRD clearance30mL/min/1.73m2), autoimmune or inflammatory disease, Gaucher disease, myeloid blood malignancy, active solid cancer, and cancer treated over the last 5years1,2,6. Google Scholar. With inflammation, there is damage to the cell membranes. In the case of incidental finding of elevated B12, the relevance of an active search for solid cancer necessitating invasive and expensive examinations remains debated5,18,19. They may offer online and in-person resources to help people live well with their disease. Elevated levels of serum cobalamin may be a sign of a serious, even life-threatening, disease. Indeed, the frequency of incident diagnoses of chronic liver diseases (32/144, 22.2%) and myeloid blood malignancies (25/144, 17.4%) in the EE group also confirmed the interest in screening these pathologies in case of persistent elevated B125,18,19. These include inflammatory bowel disease (Crohn's disease), various types of . Vitamin B 12 in serum is bound to two proteins, haptocorrin (HC) and transcobalamin (TC). Time-to-event curves for incident solid cancer were presented as KaplanMeier curves and were compared with a log-rank test. What causes high vitamin B12 levels without supplements? Vitamin B12, or cobalamin, is often associated with energy, but this nutrient is necessary for many vital processes in the human body. GP60 Clinical utility of elevated vitamin B12 levels with a J. Clin. Hi everyone. Joint pain. The B12 measurements were centralized in the biochemistry laboratory of Angers University Hospital. Lab. Implications cliniques de la dcouverte dune hypervitaminmie B12 en mdecine interne. Please enable it to take advantage of the complete set of features! Other markers that may be elevated in ALPS include plasma interleukin-10; plasma . TNF- is a hallmark of inflammation [13] and several lines of evidence suggest the association of vitamin B12 deficiency with an increased incidence of inflammation and associated metabolic complications [3,13]. When platelet levels are low, the blood does not clot well, and bleeding cannot be controlled following minor injuries. In our own daily practice, we observed spontaneous normalizations of elevated B12 level after the resolution of acute disorders (severe infections, acute inflammatory state due to immune or inflammatory diseases). Baker, H., Leevy, C. B., DeAngelis, B., Frank, O. 2015 Feb;101(4):302-10. doi: 10.1136/heartjnl-2014-306022. Markedly increased vitamin B12 concentrations attributable to IgG-IgM-vitamin B12 immune complexes. The tests were carried out on an immunoanalytical system ADVIA Centaur (SIEMENS HEALTHCARE DIAGNOSTICS Inc. Tarrytown, NY, USA) with ADVIA Centaur VB12 reagents. High Plasma Vitamin B12 and Cancer in Human Studies: A Scoping Review to Judge Causality and Alternative Explanations. As noted Granulocytes have an affinity for producing the TCN 1 and TCN3 and not so much of the TCN 2. Significantly Elevated Vitamin B12 Levels in Autoimmune
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