Macrocytic anemia

A patient presented with significant fatigue and exertional dyspnea. Further investigation revealed a hemoglobin level of 8.15 g/dL, and the patient reported a history of partial gastrectomy a few months ago. What is the most likely cause of anemia in this patient?

A patient with anemia presented with a blood test that revealed macrocytosis, poikilocytosis, and neutrophils with six lobes. What is the diagnosis?

A patient is diagnosed with anemia and has raised MCV; megaloblastic anemia is suspected. What is the earliest neurological symptom that may indicate cobalamin deficiency?

A patient has presented with symptoms of pallor and lethargy. Initial testing reveals a hemoglobin level of 9 and peripheral blood film findings consistent with macrocytosis. Further examination via a bone marrow biopsy indicates megaloblastic anemia. What would be your approach to treating this patient?

A patient diagnosed with megaloblastic anemia is undergoing treatment with folate and vitamin B12 therapy. Which of the following should be monitored?

A patient presented with anemia and macrocytosis. Megaloblastic anemia is suspected and which of the following feature in not a part of it?

A 50-year-old male presented to the neurological OPD with complaints of bilateral lower limb extremity with tingling and numbness. She has difficulty walking, especially at night. She had a history of gastric bypass surgery 06 years ago. On examination, she has gait ataxia, with loss of vibration and position sense in both lower limbs. Romberg sign is positive. Her skin has mild depigmentation as well. Investigations showed

• WBC: 8000
• Hemoglobin: 9 g/dl
• MCV: 65 fl
• Platelets: 185000
• Creatinine: 0.9 mg/dl

Which of the following is the most likely cause of her presentation

A 62-year-old was referred to the neurology clinic with a 6-month history of progressive difficulty walking, particularly at night. He describes a crawling sensation in his feet and recent emotional lability, characterized by unexpected bouts of anxiety and low mood. He has a 10-year history of Type 2 Diabetes Mellitus, which has been excellently controlled (HbA1c consistently <7.0%) since he started a strict vegetarian diet and high-dose metformin five years ago.

On examination, his blood pressure is 130/80 mmHg with no orthostatic drop. Cranial nerve examination is unremarkable. Motor strength is 5/5 in all muscle groups. However, there is a symmetrical loss of vibration and proprioception up to the ankles. Deep tendon reflexes are 3+ at the knees and ankles, and bilateral Babinski signs are present. His gait is wide-based and sensory ataxic; he is unable to maintain balance when asked to stand with his feet together and eyes closed. No cerebellar signs are noted.

Laboratory Investigations:

• Hemoglobin: 11.8 g/dL
• MCV: 98 fL
• Platelets: 240,000/mm³
• Leukocytes: 7,500/mm³
• Creatinine: 0.9 mg/dL
• HbA1c: 6.4%

Which of the following is the most appropriate next step in the management of this patient?

A 60-year-old woman has had vitiligo for the past 10 years. She now presents with a burning sensation in her lower limbs and difficulty walking. On examination, she has diminished vibration sensation in her legs. Laboratory investigations reveal hemoglobin of 8 g/dL and an MCV of 120. A peripheral film shows evidence of hypersegmented neutrophils. How would you approach the treatment of this patient?

A 40-year-old woman reports a history of burning sensations of bilateral lower limbs, fatigue, and a sore tongue. Physical examination reveals severe pallor, mild jaundice, and a smooth, shiny tongue. She also mentions a lifelong history of white skin patches. Which diagnostic test would be the most suitable to confirm the diagnosis in this case?