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For injectable routes, beyond localized reactions like pain or swelling at the injection site, observing for systemic effects becomes paramount

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If the patient is suspected to be sensitive to cobalt or other components of cobalamin, an intradermal test dose is recommended.[12][15] Several laboratory tests should be performed prior to treatment with cyanocobalamin, including serum vitamin B12, folate, iron, hematocrit, and reticulocyte count