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observations on the maintenance of a normal hematologic status and on the occurrence of combined system disease at the end of one year

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Diagnostic dilemmas could occur when patients with PA present with spuriously normal or high cobalamin levels, normocytic or microcytic anaemia, nonanaemic macrocytosis, autoimmune haemolytic anaemia, pseudo-thrombotic microangiopathy, hyperhomocysteinemia-associated thromboembolism, pseudoleukemia, bone marrow failure, and neurologic manifestations without anaemia or macrocytosis

Most practitioners recommend starting at 250-300 mcg daily to assess tolerance, then potentially increasing to 400-500 mcg if initial response is suboptimal and no side effects occur