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The clinical picture is the most important factor in assessing the significance of results of blood tests assessing cobalamin (B 12 ) status because there is no gold standard test to define deficiency Neurological symptoms resulting from B 12 deficiency may take several months or even years to resolve completely Measuring serum biomarkers such as B 12 or methylmalonic acid is neither helpful nor indicated in assessing or monitoring clinical improvement, neither is titration of injection frequency based on biomarker assessment Self-administration of intramuscular B 12 injections can lead to greater patient satisfaction and better health outcomes What is vitamin B 12