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GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count to identify macrocytic anaemia Serum B12 and folate levels to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine when B12 results are borderline Intrinsic factor antibodies if pernicious anaemia is suspected Additional tests depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord
Key aspects of the PESTO trial design include: While PESTO is designed to provide level 1 evidence on the safety and efficacy of perispinal etanercept in chronic stroke patients, the design has been criticized by some experts
Premature discontinuation prevents experiencing potential benefits requiring longer accumulation
Supplied as a general-purpose sterile laboratory reagent
Bacteriostatic water contains 0.9% benzyl alcohol
