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24 25 Some patients may experience recurrence or worsening of symptoms when the interval between injections is extended or extended too quickly, and report that continuation of frequent intramuscular hydroxocobalamin injections, varying between twice weekly and once every three to four weeks, 65 is needed to remain asymptomatic

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These reasons, while understandable from a procedural standpoint, can be clinically and emotionally detrimental to a patient with Pernicious Anemia who is symptomatic and in need of treatment