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When serum B12 results are equivocal or clinical suspicion remains high despite normal B12 levels, additional tests may be requested: Methylmalonic acid (MMA) : Elevated levels indicate functional B12 deficiency at the cellular level, though availability may be limited in primary care and levels can be elevated in renal impairment Homocysteine : Also elevated in B12 deficiency, though less specific and also affected by renal function Intrinsic factor antibodies : To investigate pernicious anaemia, the most common cause of B12 deficiency in the UK Anti-parietal cell antibodies : May be tested if pernicious anaemia is suspected but intrinsic factor antibodies are negative Identifying the underlying cause is crucial for appropriate management

Briefly, when either caspase 8 or fas-associated via death domain (FADD) is depleted or the function is inhibited, TNF can induce caspase 8 independent necrosis through activating RIPK1 (receptor interacting serine/threonine kinase 1) [94]

Anti-AGEs Benfotiamine : Benfotiamine, a lipid-soluble derivative of thiamine

The strong elution also breaks the bond between the heavy and light chains of the antibodies and therefore the antibodies will be seen on the gels