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Although B12 deficiency is not uncommon, this case highlights the need to identify its hematologic signs and differentiate ineffective erythropoiesis from actual hemolysis

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Malabsorption (inadequate intake of vitamin B12 in the intestine) Insufficient production of intrinsic factor (a protein that is produced in the gastric mucosa and is required for the absorption of vitamin B12), Diseases in the terminal part of the ileum (part of the small intestine), eg