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A doctor may still evaluate symptoms carefully, because fatigue, tingling, or brain fog can also occur with iron deficiency, thyroid disease, diabetes, sleep problems, or neurological conditions such as multiple sclerosis
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However, a diagnosis of folate deficiency should be considered in such patients when significant elevation in mean cell volume or hypersegmented polymorphonuclear leucocytes are found, especially in subjects with malnutrition, history of alcohol abuse, or in patients hyporesponsive to rHuEPO