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Availability of data and materials The dataset supporting the conclusions of this article is included within the article

The role of homocysteine in increasing the risk of hemolysis in vitamin B12 and folate deficiency has been demonstrated in vitro .[7] We postulate that the high homocysteine levels in our case may have played a role in ensuing hemolysis in addition to intramedullary destruction of RBCs

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In this case report, the neurological symptoms seemed to be due to hyperammonemia rather than elevated MMA concentration