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Fatigue that doesn’t lift with a full night’s sleep Tingling, numbness, or a pins-and-needles feeling in the hands or feet A sore, red, or unusually smooth tongue Low mood, irritability, or trouble concentrating Unsteady balance, in more advanced cases Nerve symptoms, especially tingling in the feet, can show up before a blood count looks abnormal, so fatigue alone can miss the picture

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J Dtsch Dermatol Ges (2022) 20(3):365–78

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