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The groups most likely to develop B12-related hair and skin changes are the same ones at risk for deficiency generally: vegans and vegetarians, adults over 50, people on long-term metformin or proton pump inhibitors, anyone who's had bariatric surgery, and people on GLP-1 protocols whose reduced appetite has significantly lowered their overall nutrient intake for an extended period

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Bone marrow biopsy is sometimes done to evaluate for aplastic anemia, leukemia, lymphoma, or metastatic cancer to the bone marrow