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As a result, a patient experiences a rapid, beneficial effect from the B12 deficiency treatment

For confirmed deficiency or pernicious anaemia, NICE Clinical Knowledge Summaries recommend hydroxocobalamin 1mg intramuscularly, with frequency determined by the underlying cause and neurological involvement

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However, this route is prone to generating significant quantities of unintended impurities, which complicates downstream separation and purification while resulting in relatively low recovery rates