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p38 MAPK, ERK, and JNK activations are almost exclusively found in synovial
If the GP says that she doesn't have macrocytic anaemia so doesn't need this pattern of treatment, you could point out that NICE guidelines for B12 deficiency say that "Note: clinical features of vitamin B12 deficiency can occur without anaemia and without low serum levels of vitamin B12." cks.nice.org.uk/topics/anae
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