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Importantly, serum B12 levels can be misleadingly normal or even elevated in chronic liver disease due to increased levels of binding proteins (such as haptocorrin) and reduced clearance, meaning that total B12 measurements may not accurately reflect tissue B12 status or functional deficiency

It's important to note that while vitamin B12 injections are effective in quickly raising B12 levels, dietary changes and oral supplements are often recommended for long-term maintenance

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Diagnosis involves serum B12 measurement, full blood count, and investigation for underlying causes including intrinsic factor antibodies for pernicious anaemia