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GPs will evaluate: Detailed symptom history Dietary habits and restrictions Medical history, including gastrointestinal conditions Current medications Family history of pernicious anaemia or autoimmune conditions NICE guidance emphasises that treatment should not be delayed whilst awaiting test results if clinical suspicion is high, particularly when neurological symptoms are present

People who are less likely to mount an appropriate immune response are people on steroids, who have received organ transplants, have severe HIV infections, or other conditions