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Handling: Follow standard laboratory safety protocols

Symptoms include severe persistent abdominal pain radiating to the back, nausea, vomiting, and elevated pancreatic enzymes

This typically involves: Intrinsic factor antibodies (highly specific for pernicious anaemia, though sensitivity is only 50%) [12] [28] Gastric parietal cell antibodies (more sensitive but less specific) Coeliac serology if malabsorption is suspected Consideration of upper gastrointestinal endoscopy in selected cases, particularly with autoimmune gastritis/pernicious anaemia NICE guidance emphasises that treatment should not be delayed whilst awaiting antibody results if clinical features strongly suggest deficiency, as irreversible neurological damage can occur

Others experience it as a loss of pleasure or mild emotional flatness around food. Trial mood scores moved slightly better rather than worse, so the negative experience appears to be a minority signal that standard adverse-event tables do not capture well