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While it may provide some additional energy, particularly in those who were B12 deficient in the first place, high-dose B12 is not always recommended

Common clinical drivers include: Vitamin B12 deficiency Folate deficiency Chronic liver disease Alcohol use disorder Medications (e.g., methotrexate) Bone marrow disorders Chronic inflammatory disease Hypothyroidism Key ICD-10 principle: Cell size is a laboratory observation

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Freeze-thaw cycling is especially destructive to peptides each cycle forms ice crystals that physically shear the molecule, so even one accidental freeze can tank a vial