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Intramuscular replacement therapy is indicated for patients with: Significant B12 deficiency (thresholds depend on local laboratory reference ranges) Neurological symptoms or signs Pernicious anaemia Malabsorption syndromes The standard UK regimen for patients without neurological involvement involves hydroxocobalamin 1mg intramuscularly three times weekly for two weeks, followed by maintenance injections every 2-3 months (often 3-monthly)

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This limits oxidative stress and protects surrounding tissues from chronic inflammation and aging