The diagnostic process typically involves: Clinical history taking, focusing on symptoms (fatigue, neurological changes, dietary habits) Physical examination for signs of anaemia or neurological impairment Blood tests including full blood count, serum B12, and often folate levels Additional investigations such as intrinsic factor antibodies or parietal cell antibodies if pernicious anaemia is suspected For borderline results, additional tests like holotranscobalamin (active B12) may be considered NICE guidance recommends that treatment should commence based on clinical presentation if neurological symptoms are present, without waiting for laboratory confirmation, as delays can result in irreversible nerve damage
To date, we have identified 25 genetically encoded selenoproteins in human, including glutathione peroxidase (GPx), thioredoxin reductase (TXNRD), and iodothyronine deiodinases (DIOs), which have a wide range of functions, from anti-inflammatory and antioxidant activities to thyroid hormone metabolism
Storage and Shelf Life To maintain sterility and effectiveness, bacteriostatic water must be stored properly: Keep the vial at room temperature, away from direct sunlight or extreme heat
Bisaglia M, Mammi S, Bubacco L
