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Treatment considerations include: Concurrent folate supplementation if deficient (never give folate alone, as it may precipitate neurological deterioration) Potassium monitoring during initial treatment in severe anaemia or at-risk patients (e.g., those with heart failure) Response assessment: reticulocyte count peaks at 57 days, haemoglobin normalises within 68 weeks Neurological symptoms may take 612 months to improve and may not fully resolve Patients should be advised that treatment for pernicious anaemia or post-surgical deficiency is lifelong

356,357 Targeting pathways that improve Schwann cell metabolism and support axonal energy requirements may offer new therapeutic avenues (Fig