Clinical Question-7

25-year-old woman on a vegetarian diet presented with lancinating pains mainly affecting the lower extremities. 

History of Gastrectomy one year back and treated for pulmonary tuberculosis 2 years back.

Clinical features

Patient developed gradual onset weakness followed by shortness of breath with exertion over a period of 6 months. She also noticed palpitation, and lightheadedness on several occasions.

Physical examination

Physical examination revealed pallor, tachycardia, functional heart murmur, Hunter glossitis, and splenomegaly.

Lab reports shows

Haemoglobin – 5.1 g/dL;

Mean corpuscular volume – 116 fL



What is the Most Probable Diagnosis?

A. Aplastic anemia
B. Iron deficiency anemia
C. Thalassemia
D. Megaloblastic Anemia

Deficiencies of vitamin B12 and folic acid are the leading causes of megaloblastic anemia.

Folic acid is present in food such as green vegetables, fruits, meat, and liver.

Primary dietary sources of cobalamin/vitamin B12 are meats, fish, eggs, and dairy products. Vegan diets are low in vitamin B12.

Most frequent cause of vitamin B12 deficiency is pernicious anemia caused by autoimmune gastric atrophy, leading to decreased intrinsic factor production. 

Vitamin B12 deficiency may also develop following gastrectomy, ileal resection

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