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A review indicated vitamin B12 levels in the range of 46 89 pg/mL, well below the normal reference range of 233 914 pg/mL ( BM biopsy and aspiration are generally not required to diagnose megaloblastic anemia and may create diagnostic confusion in cases of severe pancytopenia

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Following needle placement, sequential dilation, and working sheath establishment, the endoscope was inserted through the working sheath (Joimax, Germany)