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Common clinical drivers include: Vitamin B12 deficiency Folate deficiency Chronic liver disease Alcohol use disorder Medications (e.g., methotrexate) Bone marrow disorders Chronic inflammatory disease Hypothyroidism Key ICD-10 principle: Cell size is a laboratory observation

10.19460/j.cnki.0253-3685.2004.11.031 63 LinnebankM.MoskauS.SemmlerA.HoefgenB.BoppG.KallweitU.et al (2012)

What patients are really looking for when they ask about a better approach Most patients are not looking for exaggerated promises

Works well for most people

The intramuscular route is often chosen for the first treatment because it works well