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When liver function deteriorates significantly, the combination of released stored B12, increased circulating haptocorrin, and reduced hepatic clearance can result in markedly elevated total serum B12 levels

Now, history and physical exam must be "medically appropriate" for the presenting problem

Although this finding requires further investigation with respect to the functional biomarkers Hcy and MMA, the finding opens the possibility of early identification of vitamin B 12 insufficiency or deficiency during the first trimester of pregnancy and adequate treatment

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