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This impairment of DNA synthesis affects the rapidly dividing cells of the bone marrow earlier than other cells, resulting in the production of large, immature, hemoglobin-poor red blood cells (macrocytosis), as well as effects on white blood cells, including abnormal (hypersegmented) neutrophils and reduced overall cell counts (pancytopenia)

Homocysteine and methylmalonic acid (MMA) levels

125 mcg

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However, not enough is known about this theoretical issue to elucidate a risk-benefit tradeoff and how timing of treatment works into such a tradeoff