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The classic presentation of symptomatic B 12 deficiency occurs in Addison-Biermers disease, and is characterised by megaloblastic anaemia

Excretion Pathways Limited data on combined excretion indicates: Primarily renal elimination of peptide fragments Hepatic metabolism contributes to overall clearance Copper recycling through normal physiological pathways No evidence of accumulation in chronic dosing studies (animal models) The relationship between rapid plasma clearance and prolonged biological effects represents a key area requiring further mechanistic investigation across all three components

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