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Acknowledgments The authors are grateful to Yixin Wang, Wei Wang and Meiliang Pan for writing the original draft

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Patients should be reviewed 8–12 weeks after commencing treatment to assess: Symptomatic improvement, particularly resolution of fatigue and neurological symptoms Haematological response (normalisation of haemoglobin and mean cell volume) Reticulocyte count typically rises within one week, indicating bone marrow response Repeat serum B12 testing is generally not useful after starting parenteral therapy, as levels remain elevated for months