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After a delay of about 6 hours, the cobalamin appears in portal blood attached to transcobalamin II

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intestinal tract medications such as antacids or metformin lack of intrinsic factor lack of stomach acid excessive alcohol consumption [3] diabetes [3] Loss of intrinsic factor can occur, when an overactive immune system produces abnormal antibodies as a result of an autoimmune reaction, which attack and destroy the stomach cells that produce intrinsic factor