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For patients who have difficulty absorbing B12 through the digestive tractsuch as those with pernicious anemia, gastrointestinal disorders (like Crohns disease or celiac disease), a history of gastric bypass surgery, or those with severe B12 deficiencyour providers often recommend intramuscular B12 injections

If you see foam, you likely swirled too vigorously or injected the water too forcefully

The process is quick and relatively painless

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Infection-induced hemolysis

For example, a study by Zhu et al