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Murphy & Quinn, 2018

Life-long blood transfusions of packed red blood cells to keep the hemoglobin above 9g/dl is required to prevent deformity and enlargement of the spleen which is a result of inadequate blood transfusions

In the absence of B12, these cells grow to an abnormally large size as they try to capture more oxygen

Diets high in sulfur foodstuffs or water or a combination of the two can also lead to thiamine deficiency

Always check packaging integrity before use cracked vials or damaged seals should not be used

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