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NICE and BNF Guidance: You correctly point out that even official guidance from NICE and the BNF acknowledges that some individuals may require more frequent injections

9b shows atoms of Ni(II) in complex with histidine binding to InrS via associative ligand exchange

doi: 10.1016/j.cell.2014.12.026 [DOI] [PMC free article] [PubMed] [Google Scholar] 9.Rossi MA

Because SIRVA results from incorrect injection technique, it is entirely preventable

The condition primarily manifests as megaloblastic anemia with recurrent diarrhea, mouth ulcers, recurrent infections, anemia and loss of appetite, which typically occur in the first months of life