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Seek medical attention promptly if you experience symptoms that could suggest serious underlying conditions, including: Unexplained weight loss or persistent fatigue Jaundice (yellowing of skin or eyes), abdominal pain, or swelling Easy bruising or bleeding , or unusual skin rashes Night sweats , fever, or enlarged lymph nodes Reduced urine output , significant swelling in legs or ankles Persistent itching without obvious skin cause These symptoms may indicate liver disease, haematological disorders, or renal impairment—conditions that can elevate B12 and require specialist assessment