Question:
A 50-year-old man presents with paresthesia. Hemoglobin is 6.8 g/dl. Peripheral smear shows macrocytosis and neutrophils with hypersegmented nuclei. Endoscopy reveals atrophic gastritis. The most probable diagnosis is:
A 50-year-old man presents with paresthesia. Hemoglobin is 6.8 g/dl. Peripheral smear shows macrocytosis and neutrophils with hypersegmented nuclei. Endoscopy reveals atrophic gastritis. The most probable diagnosis is:
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Megaloblastic picture with neuropathy and atrophic gastritis narrows it to one vitamin.
Updated On: Jun 23, 2026
- Folate deficiency
- Vitamin B12 deficiency
- Riboflavin deficiency
- Iron deficiency
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The Correct Option is B
Solution and Explanation
Step 1: Macrocytosis with hypersegmented neutrophils points to a megaloblastic anemia, caused by either vitamin B12 or folate deficiency.
Step 2: Two extra clues separate the two. Paresthesia indicates neurological involvement (subacute combined degeneration), which is a feature of B12 deficiency, not folate deficiency.
Step 3: Atrophic gastritis destroys parietal cells, reducing intrinsic factor and impairing B12 absorption (pernicious anemia mechanism). This confirms B12, not folate, deficiency.
Conclusion: The picture of megaloblastic anemia plus neuropathy plus atrophic gastritis is vitamin B12 deficiency. Iron deficiency gives microcytic anemia, and riboflavin deficiency does not produce this picture.
Ref: Harrison's Principles of Internal Medicine.
Step 2: Two extra clues separate the two. Paresthesia indicates neurological involvement (subacute combined degeneration), which is a feature of B12 deficiency, not folate deficiency.
Step 3: Atrophic gastritis destroys parietal cells, reducing intrinsic factor and impairing B12 absorption (pernicious anemia mechanism). This confirms B12, not folate, deficiency.
Conclusion: The picture of megaloblastic anemia plus neuropathy plus atrophic gastritis is vitamin B12 deficiency. Iron deficiency gives microcytic anemia, and riboflavin deficiency does not produce this picture.
Ref: Harrison's Principles of Internal Medicine.
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