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However, clinically overt vitamin B 12 deficiency with classical feature of macrocytic anaemia and neuropathy is infrequently seen in the elderly.2 Very often they have mild, subclinical deficiency, which are usually asymptomatic.2 Clinical manifestations of vitamin B 12 deficiency are usually non-specific and are highly variable according to severity or organ systems involved.9 There is no one clinical feature unique to all patients with vitamin B 12 deficiency