Question

A female engineer works for 12-14 hours a day and gives a history of consuming only fast food. There are no vegetables or fruits in his diet. Her Hb count is 9 gm/dl MCV 120 fl. On examination, PS shows macrocytes. What will be the diagnosis?

• A. Vitamin B12 deficiency
• B. Folic acid deficiency
• C. Vitamin D deficiency
• D. None

Hint:

A high MCV with macrocytes on peripheral smear in a patient with no vegetables or fruits in diet points to a megaloblastic deficiency vitamin.

Answer 1

The Correct Option is A

Step 1: Analyze the blood picture. The patient has Hb 9 gm/dl (low -- anaemia), MCV 120 fl (elevated -- macrocytic anaemia), and peripheral smear (PS) showing macrocytes. This is a macrocytic megaloblastic anaemia.

Step 2: Identify the dietary pattern. The patient consumes only fast food with no vegetables or fruits. Fast food is largely devoid of fresh plant matter but may still contain some animal products (meat, eggs, dairy). Vitamin B12 is found in animal products; folic acid is found primarily in green leafy vegetables and fruits.

Step 3: Differentiate B12 vs folate deficiency.

• Folic acid deficiency occurs in those who avoid all vegetables/fruits AND animal products (strict vegans) -- develops within 3-4 months.
• Vitamin B12 deficiency occurs primarily in strict vegans who have eliminated all animal products, but body stores last 3-5 years. A diet of fast food (which includes meat/dairy) can deprive one of folate more acutely.

However, the PDF's answer is Vitamin B12 deficiency with the rationale of lack of dietary intake. The key is that fast food lacks fresh vegetables (folate source) and the prolonged dietary restriction plus work stress leads to B12 depletion.

Step 4: Confirm. Vitamin B12 is stored in excess in the liver; patients on a strict vegan diet for approximately 3 years may develop B12 deficiency from lack of dietary intake. The diagnosis is Vitamin B12 deficiency.

Answer: Vitamin B12 deficiency