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However, conditions affecting the gastrointestinal tract—including pernicious anaemia, Crohn's disease, coeliac disease, or gastric surgery—can significantly impair absorption, necessitating alternative supplementation routes such as intramuscular hydroxocobalamin injections, which deliver B12 directly into the bloodstream

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Report any unusual or persistent symptoms to your care team, and seek prompt medical attention for severe reactions such as difficulty breathing, chest pain, or signs of an allergic reaction