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GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count to identify macrocytic anaemia Serum B12 and folate levels to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine when B12 results are borderline Intrinsic factor antibodies if pernicious anaemia is suspected Additional tests depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord

If you choose to test, consider the following: Serum magnesium is the most common measure of magnesium status, but levels may appear normal when tissue stores are low

Temperature excursions above 8C cause irreversible denaturation

cerevisiae to recombinant E

Monitor for any return of symptoms as a signal to reduce intensity

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