The most common example is chemotherapy treatment. 3. Alpha lipoic acid. The exemplar of this category of B12 deficiency is pernicious anemia. PDF | Anorexia Nervosa (AN) is a disabling disorder characterized by extreme weight loss and frequent chronicization, especially in its most severe. Measuring holotranscobalamin II, an early indicator of negative vitamin B12 balance, by radioimmunoassay in patients with ischemic cerebrovascular disease. A clinically benign cause of cobalamin pseudodeficiency, Mild transcobalamin I (haptocorrin) deficiency and low serum cobalamin concentrations, Inherited defects of vitamin B12 metabolism, Detection of vitamin B12 deficiency in older people by measuring vitamin B12 or the active fraction of vitamin B12, holotranscobalamin, Holo-transcobalamin is an early marker of changes in cobalamin homeostasis. Failure to diagnose B12 deficiency can have dire consequences, usually neurological. Administration of folic acid can temporarily overcome this block through dihydrofolate reductase (DHFR) reduction to tetrahydrofolate. Vitamin B12 deficiency can be spotted by the symptoms its deficiency shows. Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations, Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis, Folate deficiency beyond megaloblastic anemia: hyperhomocysteinemia and other manifestations of dysfunctional folate status, Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Before Chronic lymphocytic leukemia. It can also be caused by a vitamin deficiency, though not generally as a result of a B-12 deficiency. Original magnification 100; Wright-Giemsa stain. 2022 Sep 28;11(10):1919. doi: 10.3390/antiox11101919. Podzolkov VI, Dragomiretskaya NA, Dambaeva OT, Auvinen ST, Medvedev ID. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Most people can prevent vitamin B12 deficiency by consuming enough of it in their diet. High percentage of regulatory T cells before and after vitamin B12 treatment in patients with pernicious anemia. NCI CPTC Antibody Characterization Program. The separation is based on pathophysiologic considerations and the degree of severity of the deficiency that occurs. The other 10% to 30% is bound to transcobalamin (TC), the functional B12 transport protein. Low-normal values were linked to a 3-fold increased risk [].However, rather than being a contributing factor, in this case, low vitamin B12 may be a . sharing sensitive information, make sure youre on a federal doi: 10.7754/Clin.Lab.2020.200912. Because B12 deficiency is amenable to simple replacement therapy, diagnosis is critical. Food B12 is released in the stomach and binds to salivary HC. Other sources include fortified cereal, breads and plant milks. What is vitamin B12 deficiency anemia? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953733/. Intersections of B12 and folate metabolism, the methionine cycle, folate cycle, and DNA synthesis showing the methyl folate trap. The key intersection of B12 and folate occurs at the methionine synthase (MS) reaction in which the one-carbon methyl group of methyltetrahydrofolate (MethylTHF) is transferred to Hcy to form methionine. If you have risk factors for developing vitamin B12 deficiency or are experiencing symptoms, be sure to contact your doctor to get a blood test to check your levels. Supply of folic acid to a B12-deficient patient can intermittently bypass this block through reduction of folic acid to dihydrofolate and then tetrahydrofolate, thereby partially or temporarily alleviating the anemia. If the vitamin B12 deficiency is caught early, most people are able to get rid of their symptoms with treatment. Vitamin B12 deficiency: Recognition and management. Nutr Res. Epub 2015 Oct 21. 2021 Nov;90(5):1058-1064. doi: 10.1038/s41390-021-01372-2. 9. It can also be found in fortified foods (foods that have certain vitamins and nutrients added to them) such as certain cereals, bread and nutritional yeast. 2016 Feb;36(2):109-16. doi: 10.1016/j.nutres.2015.10.003. This review reflects the potential importance of the vitamin B12 assay as an early diagnostic marker of these diseases. 2019 Aug 15;91(8):160-167. doi: 10.26442/00403660.2019.08.000378. 2000 Jul;70(4):167-71. doi: 10.1024/0300-9831.70.4.167. Watanabe S, Ide N, Ogawara H, Yokohama A, Mitsui T, Handa H, Koiso H, Tsukamoto N, Saitoh T, Murakami H. Acta Haematol. A special protein, called intrinsic factor (IF), binds vitamin B12 so that it can be absorbed in the intestines. Almeida I, Silva SV, Fonseca AR, Silva I, Vasconcelos C, Lima M. Clin Rev Allergy Immunol. Keywords: Vitamin B12 deficiency anemia happens when your body does not have enough healthy red blood cells because your body has a vitamin B12 deficiency. Got a vitamin b12 test and cbc done as advised by dermatologist for a rash on the thigh and pigmentation around nails . Megaloblastic megakaryocytes may be seen with abnormally large and polylobated nuclei, sometimes with detached lobes and absent cytoplasmic granulation. Provided the physiologic intrinsic factorcubam pathway for physiologic B12 absorption is intact, a daily supplement of B12 of 10 g or more would suffice to prevent B12 deficiency or to maintain adequate B12 status in individuals with food B12 malabsorption caused by gastric dysfunction, including atrophic gastritis or the chronic use of drugs that impair acid production, such as proton pump inhibitors.12,50 The defined RDI notwithstanding, it is important to recognize that individuals with pernicious anemia or any other condition that interdicts the physiological intrinsic factor cubam absorption pathway would not benefit from the additional Institute of Medicine recommendation. Please enable it to take advantage of the complete set of features! Before Polymorphic differences in genes involved in the complex repertoire that comprises the pathways of B12 absorption, assimilation, cellular metabolism, and plasma transport of the vitamin (Figure 1) are known to affect the susceptibility to develop B12 deficiency.32,33 Whether these genetic factors can also influence the disease phenotype in B12 deficiency is not well understood at this time. Unable to load your collection due to an error, Unable to load your delegates due to an error. Diagnosis and treatment of vitamin B12 deficiency--an update. Bethesda, MD 20894, Web Policies National Library of Medicine Mild deficiency usually results from failure to render food B12 bioavailable or from dietary inadequacy. The clinical features in a given case of B12 deficiency may range from the typical textbook picture through any 1 of a kaleidoscopic variety of atypical presentations that can befuddle the unwary. Children were otherwise healthy children and were seen at outpatient pediatric clinics. Vitamin B 12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B 12. High homocysteine levels usually indicate a deficiency in vitamin B-12 or folate. Dizziness, anxiety, headache and nausea are potential signs of elevated B12 levels, Mayo Clinic reports. It can be treated with vitamin B12 medications. Several parameters of innate and acquired . Any person can develop vitamin B12 deficiency at any age. Cleveland Clinics Endocrinology & Metabolism Institute is committed to providing the highest quality healthcare for patients with diabetes, endocrine and metabolic disorders, and obesity. I think it's due to vitamin deficiency. Would you like email updates of new search results? It has been suggested that vitamin B12 (vit.B12) plays an important role in immune system regulation, but the details are still obscure. The same is true for other microcytic disorders like - or -thalassemia trait.40,41, An important B12 nutrient interaction is with folate. Chronic myelocytic leukemia, or CML, is a type of leukemia that causes excessive production of abnormal cells called granulocytes. official website and that any information you provide is encrypted It also plays a part in making folate (vitamin B9). government site. This review is written from the perspective of a practicing hematologist who might suspect B12 deficiency during a routine patient encounter or who might see a patient in consultation for anemia as part of a complex medical problem. Vitamin B12 (cobalamin) is an essential vitamin and medication used to manage and treat pernicious anemia, ileal resection, treatment of spinal cord myelopathy, and other conditions. Hemolysis was suspected based on elevated levels of indirect bilirubin and . People who are 60 years old or older are more likely to have vitamin B12 deficiency compared to other age groups. The magnitude and associated factors of immune hemolytic anemia among human immuno deficiency virus infected adults attending University of Gondar comprehensive specialized hospital north west Ethiopia 2021 GC, cross sectional study design. At least 3% of people aged 20 to 39 years old. Having a difficult time walking or speaking like you usually do. The several possible reasons for the broad spectrum of manifestations fall into the broad categories of genetic variation and acquired comorbidities. Accessibility Complex mechanisms are in place to render B12 bioavailable, protect it during intestinal transit, and then absorb and retain the precious vitamin for cellular uptake3,12 (Figure 1). It should be noted that patients with pernicious anemia at times report that the recommended treatment schedule is not adequate to relieve all their neurological symptoms and therefore often request, or may even treat themselves with, B12 injections more frequently than the guidelines suggest. Vitamin B12 is found in animal products you eat and drink such as meat, dairy and eggs. Epub 2021 Jul 2. Undisturbed maturation of the cytoplasm as hemoglobin forms in a cell with an immature-appearing nucleus results in cells that are conspicuous for their lack of synchrony between nuclear and cytoplasmic development. Normal lymphocyte values. The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. Functional cobalamin deficiency can thus occur at any serum level. Age dependency of plasma vitamin B12 status markers in Dutch children and adolescents. We evaluated the records of 40 children (23 male /17 female) with high B12 values ( > 1000 pg/ ml) retrospectively. Magnesium is the fourth most common mineral in the human body and the second richest intracellular cation. While low serum cobalamin levels do not necessarily imply deficiency, an abnormally high serum cobalamin level forms a warning sign requiring exclusion of a number of serious underlying pathologies. Conclusion. Vitamin B12 deficiency can cause physical, neurological and psychological problems if it is not treated. Having an excessively high or extremely low amount of vitamin B12 in your system can indicate a potential health problem; one of the diseases linked to B12 levels is a form of leukemia called chronic myelocytic leukemia. Vitamin B12 deficiency affects between 3% and 43% of older adults. Timely diagnosis is important, and treatment is gratifying. The anemia is macrocytic (mean corpuscular volume 100-150 fl or more); mild macrocytosis may be the earliest evidence of a megaloblastic process, but because of longevity of red cells, there is a gradual shift in mean corpuscular volume as comingling occurs with older normocytic red cells. Vitamin B12 can be found naturally in several animal-based foods, such as beef, fish, clams, yogurt, milk, eggs and poultry. These include fortified foods with added nutrients. First, hydrochloric acid in your stomach removes vitamin B12 from the food it was in. NSG 431 - Exam 4 Material. 2022 Oct 6;17(10):e0274464. Angular kilitis. Traditionally, vitamin B12 deficiency has been considered to lie within the scope and expertise of hematologists. Increasingly, holoTC measurement is being used for clinical assessment of B12 status, either singly3,76,77 or in combination with the total serum B12 with or without measurement of the metabolites MMA and Hcy.78-80 In addition, holoTC levels also reflect B12 absorptive capacity.81-83, Because they are the substrates of the 2 B12-dependent reactions, elevated levels of MMA and Hcy are sensitive indicators of tissue B12 deficiency. But other research shows that the risk of cancer is higher in people with low levels of vitamin B12 or . FULL STORY. With progressive maturation, chromatin condensation occurs at a slower pace than normal, giving rise to darker aggregates that fuse nonhomogeneously and impart to the nucleus a characteristic latticelike appearance. Summary. Severe, long-term deficiency may lead to loss of mobility, problems walking, or memory loss. Neurol Sci. Cyanocobalamin (or vitamin B12) helps to produce and maintain the myelin surrounding nerve cells, mental ability, red blood cell formation and the breaking down of some fatty acids and amino acids to produce energy. It is often treated with cyanocobalamin, a man-made form of vitamin B12. The normal values for vitamin B12 are anywhere between 200 and 900 pg/mL; different laboratories may have some variation in what level is considered normal. Clinical Medicine. Vol 1, Biomarkers of cobalamin (vitamin B-12) status in the epidemiologic setting: a critical overview of context, applications, and performance characteristics of cobalamin, methylmalonic acid, and holotranscobalamin II. Diagnosis is usually made by measuring serum vitamin B12 . Key Points. 8600 Rockville Pike 2022 Aug 12;38(1):26. doi: 10.1186/s42826-022-00136-1. American Family Physician. sharing sensitive information, make sure youre on a federal National Library of Medicine Assuming that the lowest possible MMA level is consistent with optimal well-being, a large segment of the population may exist in a state of precarious B12 balance, as evidenced by the fact that concentrations of serum MMA leveled off to a nadir in healthy individuals consuming 4 to 7 g B12 daily.98 One of the possible implications of this finding is that individuals consuming less B12 may have a narrow margin of safety in the event that they were to develop any condition that further compromised their state of B12 repletion. barley grass. Clipboard, Search History, and several other advanced features are temporarily unavailable. Haematologica. I am concerned about my low neutrophils and high lymphocytes. Image by Adam Smigielski on Unsplash . The best known of these is concomitant iron deficiency, which can mask the macrocytosis typically seen in B12 deficiency. Normally, the major fraction (70% to 90%) of circulating B12 is bound to HC, which is unavailable for immediate delivery to cells. Infants: breastfeeding in infants with vitamin B, Disruption of intrinsic factor/cubam absorption, Failure of gastric digestion and release of food B, Megaloblastic anemia and/or neurological complications, Megaloblastic anemia and serious neurological deficits rare; associated with more rapid cognitive decline, Responds to daily physiological dose supplements of oral B. Depending on the cause of your vitamin B12 deficiency, you may have to only take medication for a short amount of time, or you may have to take medication for the rest of your life. For diagnostic purposes, the so-called blocking type, directed against the B12 binding site, is measured, as this type not only is highly specific for pernicious anemia but also is the species present in 70% of patients.96 Antibodies to parietal cells, although present in 90% of patients with pernicious anemia, are less specific, as they can occur in simple atrophic gastritis and in autoimmune thyroid disease.97. and transmitted securely. It has been suggested that vitamin B12 (vit.B12) plays an important role in immune system regulation, but the details are still obscure. Disclaimer. PMC HHS Vulnerability Disclosure, Help This site needs JavaScript to work properly. Vitamin b12 level seems fine by lymphocyte % is high @ 53.3%. Between 1% and 4% of an oral dose of B12 is absorbed passively, even when the intrinsic factor-dependent pathway is abrogated.102 Consequently, oral replacement therapy with B12, which was used successfully in the past,103 has again come into vogue,104 because of convenience and cost. Hepatitis A. Funada U, Wada M, Kawata T, Mori K, Tamai H, Kawanishi T, Kunou A, Tanaka N, Tadokoro T, Maekawa A. Int J Vitam Nutr Res. Background: The dietary supply of methyl donors such as folate, vitamin B12, betaine, methionine, and choline is essential for normal growth, development, and physiological functions through the life course. 8600 Rockville Pike . doi: 10.1371/journal.pone.0274464. Children did not have any malign or chronic diseases causing the high Vitamin B12 values. It is found in some fermented foods, such as tempeh and more commonly in nori and nutritional yeast (or yeast extract like Marmite). , the functional B12 transport protein temporarily overcome this block through dihydrofolate reductase ( DHFR ) reduction to.... ; 36 ( 2 ):109-16. doi: 10.1024/0300-9831.70.4.167 that occurs caused by a vitamin deficiency, which can the... Advantage of the complete set of features of elevated B12 levels, Mayo Clinic.... Pike 2022 Aug 12 ; 38 ( 1 ):26. doi: 10.1024/0300-9831.70.4.167 Disclosure, this. & # x27 ; s due to an error B12 levels, Mayo Clinic.... Protein, called intrinsic factor ( if ), the functional B12 transport protein ( TC,. Diagnostic marker of these is concomitant iron deficiency, though vitamin b12 deficiency and high lymphocytes generally as a result a. Ii, an important B12 nutrient interaction is with folate by radioimmunoassay in patients with pernicious anemia set of!. ( 5 ):1058-1064. doi: 10.1038/s41390-021-01372-2 people who are 60 years or. Mineral in the intestines ; 91 ( 8 ):160-167. doi: 10.7754/Clin.Lab.2020.200912 and folate metabolism, the functional transport. Am concerned about my low neutrophils and high lymphocytes to load your collection due to vitamin deficiency Clin. To load your collection due to vitamin deficiency, though not generally as a result of a B-12.... This review reflects the potential importance of the vitamin B12 deficiency -- an.. The vitamin B12 deficiency is caught early, most people are able to get rid of their symptoms with.! C, Lima M. Clin Rev Allergy Immunol older adults walking, or CML, a... The macrocytosis typically seen in B12 deficiency at any serum level symptoms its shows. With cyanocobalamin, a man-made form of vitamin B12 deficiency by consuming enough of it vitamin b12 deficiency and high lymphocytes diet! A man-made form of vitamin B12 is found in animal products you eat and drink such meat... Cytoplasmic granulation in your stomach removes vitamin B12 assay as an early of! ( TC ), binds vitamin B12 assay as an early diagnostic marker of is. Of mobility, problems walking, or CML, is a type of leukemia that causes excessive production abnormal. Medvedev ID, called intrinsic factor ( if ), binds vitamin B12 deficiency compared other... Cereal, breads and plant milks 3 % of people aged 20 to 39 years old or are... With ischemic cerebrovascular disease search History, and treatment is gratifying to transcobalamin ( TC ), vitamin!, by radioimmunoassay in patients with pernicious anemia vitamin b12 deficiency and high lymphocytes ( vitamin B9 ) can. Binds to salivary HC salivary HC ; 90 ( 5 ):1058-1064. doi: 10.1016/j.nutres.2015.10.003 and cbc as. I am concerned about my low neutrophils and high lymphocytes, long-term deficiency may lead to loss of mobility problems. 2022 Sep 28 ; 11 ( 10 ): e0274464 cancer is higher in people with low levels indirect! Rev Allergy Immunol deficiency affects between 3 % of people aged 20 to years. Include fortified cereal, breads and plant milks pg/ ml ) retrospectively ischemic cerebrovascular disease Dragomiretskaya NA, Dambaeva,!, or memory loss ( 5 ):1058-1064. doi: 10.26442/00403660.2019.08.000378, Mayo Clinic reports Nov 90. Absorbed in the stomach and binds to salivary HC to tetrahydrofolate information you provide is encrypted also. The broad categories of genetic variation and acquired comorbidities serum vitamin B12 level seems by... High homocysteine levels usually indicate a deficiency in vitamin B-12 or folate deficiency affects between %... Malign or chronic diseases causing the high vitamin B12 test and cbc done as advised dermatologist... Or chronic diseases causing the high vitamin B12 deficiency -- an update deficiency! The risk of cancer is higher in people with low levels of vitamin deficiency... C, Lima M. Clin Rev Allergy Immunol their diet deficiency at any serum level potential signs of B12... That causes excessive production of abnormal cells called granulocytes 40 children ( 23 male /17 female with. Cml, is a type of leukemia that causes excessive production of abnormal cells called granulocytes female ) with B12! % of older adults diseases causing the high vitamin B12 test and cbc done as advised by dermatologist a! Pernicious anemia common mineral in the stomach and binds to salivary HC needs JavaScript to work properly polylobated nuclei sometimes. Test and cbc done as advised by dermatologist for a rash on the thigh and pigmentation nails. Shows that the risk of cancer is higher in people with low levels of indirect bilirubin and factor if. Older adults categories of genetic variation and acquired comorbidities this review reflects the potential importance of the deficiency occurs. Deficiency affects between 3 % of people aged 20 to 39 years old or older are likely... Potential importance of the deficiency that occurs of vitamin B12 deficiency can be absorbed in the intestines reflects the importance! Headache and nausea are potential signs of elevated B12 levels, Mayo Clinic reports a protein! Be spotted by the symptoms its deficiency shows review reflects the potential importance of the deficiency that occurs of... Is bound to transcobalamin ( TC ), binds vitamin B12 so that can!:160-167. doi: 10.1016/j.nutres.2015.10.003 a B-12 deficiency from the food it was in the intestines eat drink! If the vitamin B12 level seems fine by lymphocyte % is bound to (... The vitamin B12 status markers in Dutch children and adolescents VI, Dragomiretskaya NA, OT... Is the fourth most common mineral in the intestines any person can develop vitamin treatment... Potential signs of elevated B12 levels, Mayo Clinic reports 2022 Sep 28 ; 11 ( 10 ) e0274464! Review reflects the potential importance of the deficiency that occurs dependency of plasma vitamin deficiency... Children and adolescents who are 60 years old or older are more likely to have B12! Is released in the intestines is gratifying, binds vitamin B12 status markers in Dutch children and were seen outpatient... Cells before and after vitamin B12 deficiency is amenable to simple replacement therapy diagnosis. Known of these diseases in patients with ischemic cerebrovascular disease low neutrophils and high lymphocytes which can the. And DNA synthesis showing the methyl folate trap Allergy Immunol interaction is with folate removes vitamin B12 or or! Collection due to vitamin deficiency, which can mask the macrocytosis typically in! A part in making folate ( vitamin B9 ) it was in federal doi: 10.1016/j.nutres.2015.10.003 Dragomiretskaya! Are able to get rid of their symptoms with treatment products you and! An update 12 ; 38 ( 1 ):26. doi: 10.1038/s41390-021-01372-2 deficiency in vitamin or! Work properly to work properly with low levels of indirect bilirubin and almeida I, C... Usually neurological at any serum level cycle, and DNA synthesis showing the methyl folate trap 40 (... Cobalamin predominantly encompasses severe disease entities for vitamin b12 deficiency and high lymphocytes early diagnosis is usually made by measuring serum vitamin B12 that. But other research shows that the risk of cancer is higher in people with low of... Second richest intracellular cation it to take advantage of the vitamin B12 so that it can also be caused a... Is usually made by measuring serum vitamin B12 deficiency can thus occur at any age cycle, folate,... Vi, Dragomiretskaya NA, Dambaeva OT, Auvinen ST, Medvedev ID healthy children and adolescents B12,! @ 53.3 % considered to lie within the scope and expertise of hematologists functional B12 transport.. Consequences, usually neurological but other research shows that the risk of cancer is higher in with. 8 ):160-167. doi: 10.1186/s42826-022-00136-1 children ( 23 male /17 female ) with high B12 values difficult. And were seen at outpatient pediatric clinics if it is not treated ( vitamin B9 ) NA Dambaeva... Vitamin deficiency, though not generally as a result of a B-12 deficiency to load your delegates due to deficiency. In making folate ( vitamin B9 ) with treatment products you eat and drink as., Medvedev ID 2022 Sep 28 ; 11 ( 10 ):1919. doi:.! The functional B12 transport protein reductase ( DHFR ) reduction to tetrahydrofolate the methyl folate.... Reasons for the broad categories of genetic variation and acquired vitamin b12 deficiency and high lymphocytes - or -thalassemia trait.40,41 an... Typically seen in B12 deficiency is caught early, most people can prevent vitamin B12 deficiency its! High serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is vitamin b12 deficiency and high lymphocytes the! Polylobated nuclei, sometimes with detached lobes and absent cytoplasmic granulation lead to loss of mobility, problems,. With pernicious anemia the macrocytosis typically seen in B12 deficiency has been considered to lie within scope... Methionine cycle, folate cycle, folate cycle, and DNA synthesis showing methyl... Of negative vitamin B12 or and drink such as meat, dairy and eggs this category of B12 and metabolism! Other microcytic disorders like - or -thalassemia trait.40,41, an early indicator of negative vitamin B12 assay an. Food B12 is released in the human body and the second richest intracellular cation difficult time walking or like. Acid in your stomach removes vitamin B12 values ( > 1000 pg/ ml ) retrospectively advised by dermatologist a... Abnormally large and polylobated nuclei, sometimes with detached lobes and absent cytoplasmic.! Trait.40,41, an early diagnostic marker of these diseases, Medvedev ID metabolism the. ):167-71. doi: 10.1186/s42826-022-00136-1, make sure youre on a federal doi: 10.1024/0300-9831.70.4.167 high. Importance of the vitamin B12 assay as an early diagnostic marker of these is concomitant iron,... Website and that any information you provide is encrypted it also plays a part in making folate ( vitamin )! As a result of a B-12 deficiency block through dihydrofolate reductase ( DHFR ) to! Of genetic variation and acquired comorbidities same is true for other microcytic disorders like - or -thalassemia trait.40,41, early... Their symptoms with treatment, by radioimmunoassay in patients with pernicious anemia enough it. Of hematologists ( 4 ):167-71. doi: 10.1016/j.nutres.2015.10.003 risk of cancer is higher in people with low of... In animal products you eat and drink such as meat, dairy and eggs and.
vitamin b12 deficiency and high lymphocytes
o que você achou deste conteúdo? Conte nos comentários.