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[42] described that endothelial dysfunction occurs in the pulmonary arteries of COPD patients with end-stage disease as evaluated by in vitro experiments measuring relaxation of pulmonary artery rings using increasing doses of exogenous acetylcholine and adenosine diphosphate (ADP)

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49 Other symptoms related to cobalamin deficiency are elevated lactic dehydrogenase levels, mechanical hemolysis, thrombocytopenia, intravascular coagulation thrombosis, low reticulocyte count, vasoconstriction, and renal and pulmonary vasculopathy