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If reticulocytes have not increased after treatment or if reticulocyte counts do not continue at least twice normal as long as the hematocrit is less than 35%, diagnosis or treatment should be reevaluated

Autoimmune and inflammatory conditions : Diseases such as rheumatoid arthritis or lupus can cause high B12 levels

Since the neural tube closes by about 4 weeks after conception, its critical that your body has sufficient vitamin B12 stores before pregnancy