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Community reports and practitioner protocols converge on the same structure: 2 to 4 weeks on, 2 weeks off

This is great for those who didnt get better with other treatments or have long-term ITP

This design choice introduces potential bias, particularly for subjective outcomes, but it reflects the practical reality that these treatments have different injection devices and titration schedules that would make blinding extremely difficult

Metabolic and neurological functions of B12 include: Energy metabolism : B12 acts as a cofactor for methionine synthase and methylmalonyl-CoA mutase, enzymes involved in cellular energy production