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Often when they appear, it is due to a simple failure in measurement

The lack of adequate cobalamin in the body hinders the regeneration of tetrahydrofolate, which eventually leads to megaloblastic anemia due to the functional folate deficiency.[9][10] On the other hand, the methylmalonyl-CoA mutase helps to metabolize odd chain fatty acids and branch chain amino acids.[5] Cobalamin is also thought to keep the bodys level of sulfhydryl (SH) groups in reduced form

Each time a dose is withdrawn with a sterile needle, the benzyl alcohol prevents microbial contamination from multiplying in the vial

But, if they are chosen and placed badly, they will look awful