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these effects lead to increased vascular permeability and mitogenesis (42, 43)

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Recommended investigations include: Full blood count with blood film examination Serum vitamin B12 level Serum folate (to exclude combined deficiency) Intrinsic factor antibodies Thyroid function tests (autoimmune association) Consider MMA and homocysteine if diagnosis uncertain and available Neurological examination should be performed in all patients, assessing for peripheral neuropathy, proprioception loss, and signs of subacute combined degeneration of the spinal cord