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Am Rev Respir Dis, 126(3): 420-428

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Acknowledgements This work was supported by the National Natural Science Foundation of China (21102182), the Natural Science Foundation of Jiangsu Province (BK2012760, China), Fundamental Research Funds for the Central Universities (2632018ZD09, China), and Excellent Science and Technology Innovation Team of Jiangsu Province Universities in 2015 (China)

Diagnosing this condition requires a sharp eye for these signals, and often involves blood tests that check B12 levels, a complete blood count, and antibodies related to intrinsic factor