Question

A 50-year-old man presents with paresthesia HB-6.8g/dl. Peripheral smear shows macrocytosis and neutrophils with hypersegmented nuclei. Endoscopy reveals atrophic gastritis. A most probable diagnosis is

• A. Folate deficiency
• B. Vitamin B₁₂ deficiency
• C. Riboflavin deficiency
• D. Iron deficiency

Answer 1

The Correct Option is B

A 50-year-old man presents with paresthesia, and lab findings show a hemoglobin level of 6.8 g/dl. A peripheral blood smear reveals macrocytosis and hypersegmented neutrophils. Additionally, endoscopy indicates atrophic gastritis. These clinical findings suggest a deficiency leading to a specific type of anemia.

The symptoms and laboratory results can be analyzed as follows:

• Paresthesia: This symptom can be associated with neurological effects of certain vitamin deficiencies.
• Macrocytosis and hypersegmented neutrophils: These are hallmarks of megaloblastic anemia, characterized by larger than normal red blood cells and abnormal white blood cell morphology.
• Atrophic gastritis: This can lead to reduced production of intrinsic factor, necessary for vitamin B₁₂ absorption.

The combination of macrocytosis, hypersegmented neutrophils, neurological symptoms, and gastric abnormalities strongly suggests a deficiency in Vitamin B₁₂, rather than folate, riboflavin, or iron deficiencies. Folate deficiency also causes macrocytosis and hypersegmented neutrophils but lacks neurological symptoms and is not typically associated with atrophic gastritis.

The most probable diagnosis is Vitamin B₁₂ deficiency.