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Conditions include alcoholic liver disease, viral hepatitis, cirrhosis, and primary or metastatic liver cancer Renal dysfunction : Impaired kidney function reduces B12 elimination, causing accumulation even with normal intake Haematological conditions : Myeloproliferative neoplasms, chronic myeloid leukaemia, polycythaemia vera, and hypereosinophilic syndrome increase transcobalamin production, elevating total serum B12 Laboratory interference : Macro-B12 (immunoglobulin-bound B12) and assay interference can cause spuriously elevated results without true excess In clinical practice, unexplained hypercobalaminaemia should prompt investigation for underlying disease, particularly in patients without obvious supplementation history

Pathological causes of elevated B12 warrant careful consideration: Haematological disorders : Myeloproliferative neoplasms (polycythaemia vera, chronic myeloid leukaemia), acute leukaemia, and lymphoproliferative disorders can increase B12-binding proteins (transcobalamin and haptocorrin), elevating total serum B12 [3] Liver disease : Hepatocellular damage releases stored B12 into circulation

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Do not mix reconstituted BPC-157 with any acidic or oxidizing solution in the same syringe