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The asparagine-glycine sequence forms a cyclic imide intermediate that can hydrolyze into either aspartate or iso-aspartate, fundamentally altering the peptide structure

Clinical indications include deficiency due to inadequate diet or malabsorption, drug-induced deficiency (for example, from long-term isoniazid or oral contraceptives), and certain inborn errors of metabolism (such as pyridoxine-dependent seizures or sideroblastic anemia)

Further testing with complete blood count (CBC) can identify consequent anemia and/or enlarged red blood cells

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