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Cyanocobalamin should not be given before a diagnosis has been fully established because of the possibility of masking symptoms of subacute degeneration of the spinal cord

doi: 10.3389/fimmu.2022.1087597 25 SpicaDJunkerTDickenmannMSchaubSSteigerJRfliTet al

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it is produced by traditional organic synthesis and supplied as a crystalline solid for laboratory reconstitution in a research-appropriate solvent