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Patients frequently experience: Fatigue and generalised weakness that persists despite adequate rest Breathlessness on exertion due to anaemia Palpitations and reduced exercise tolerance Pallor of the skin and mucous membranes These symptoms result from megaloblastic anaemia, where impaired DNA synthesis leads to the production of abnormally large, dysfunctional red blood cells with reduced oxygen-carrying capacity

Enhanced BBB permeability can be seen as a result of peripheral inflammation, mediated by alterations in the expression of TJs and transporters

Biol Trace Elem Res 202:39994006

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Serotonin is a regulator of numerous physiological activities, including behavior, mood, memory, neurogenesis, embryonic development, smooth muscle homeostasis, liver homeostasis, and gastrointestinal homeostasis 17,18,19