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In the presence of megaloblastosis on the blood smear and equivocal cobalamin serum levels, the diagnosis can be securely made only by showing degeneration of the spinal cord.14 All people over 65 years of age who are malnourished, all people in institutions or psychiatric hospitals, and all people with hematological or neuropsychiatric manifestations of cobalamin deficiency as reported in Table 2 should have their serum cobalamin levels measured
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