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53 Low B 12 concentrations in the body may be present in different pathophysiological situations, including pregnancy, old age, smoking, and comorbidities such as hypertension, diabetes mellitus, pancreatic insufficiency, autoimmune gastritis, gastrectomy or gastric bypass, diseases or resection of the ileum, bacterial overgrowth, celiac disease, inflammatory bowel disease, or uremia-related malnutrition

It can also spread through instruments contaminated with blood used in tattooing or medical procedures

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