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Patients frequently experience: Fatigue and generalised weakness that persists despite adequate rest Breathlessness on exertion due to anaemia Palpitations and reduced exercise tolerance Pallor of the skin and mucous membranes These symptoms result from megaloblastic anaemia, where impaired DNA synthesis leads to the production of abnormally large, dysfunctional red blood cells with reduced oxygen-carrying capacity

Lymphocyte-derived ACh regulates local innate but not adaptive immunity

That quick response is one reason injections are often recommended for people with ongoing fatigue or confirmed deficiency

59 Thus, patients with MD often present with abnormalities in their connective tissue, including osteopenia, skin laxity, arterial aneurysms, and spontaneous fractures

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